Exam Cram

• Helicobacter Pylori (H. Pylori) infects the stomach and duodenum

• Causes peptic ulcers > gastric cancer

• Investigation: urea breath test

• Management: (PAC)- PPI, amoxicillin, clarithromycin with 4 week test of cure (breath test)

Outline

Background 

Incredible story of discovery around individual who gave himself the infection, peptic ulcers and then treated himself successfully- winning the Nobel prize. 

H. pylori is a ground commensal, can often be asymptomatic. 

Not implicated in reflux and treating for H. pylori can exacerbate reflux. 

Cause of gastric MALToma's- management of which is H. pylori treatment. 

Implicated in 90% duodenal ulcers

Assessment

History

• Asymptomatic

• Peptic ulcer, gastric or duodenal cancers- epigastric pain, haematemasis, malena, dyspepsia

Examination

• Epigastric tenderness

Investigations

• Urea Breath Test: carbon13 broken down by H.pylori

• Duodenal biopsies during endoscopy

Diagnosis

Diagnostic criteria: +ve urea breath test or biopsies

Management

• PAC: PPI, amoxicillin and clarithromycin

Med Reg Notes

Indications for Test of Cure

• Poor compliance

• Aspirin or NSAIds indicated, particularly with history of peptic ulcer disease

• Family history of gastric malignancy

• Ongoing dyspepsia or patient anxiety requesting test

Resources and References

NICE DU H.pylori guideline

Written in 2025.