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Helicobacter pylori - Coggle Diagram
Helicobacter pylori
Pharmacology
PPI
Omeprazole 20 mg BD
Lansoprazole 30 mg BD
Esomeprazole 20 mg BD
Pantoprazole 40 mg BD
2. Clarithromycin
Clarithromycin 500 mg BD
3. Amoxicillin OR Metronidazole
Amoxicillin 1 g BD
If penicillin‑allergic: Metronidazole 400 mg TDS
Second‑line: Bismuth Quadruple Therapy (10–14 days)
1. PPI
Standard dose BD
2. Bismuth
Bismuth subcitrate 120 mg QDS or
Bismuth subsalicylate 300 mg QDS
3. Tetracycline
Tetracycline 500 mg QDS
4. Metronidazole
Metronidazole 400 mg TDS–QDS
Levofloxacin‑based triple therapy
PPI BD
Levofloxacin 250–500 mg OD
Amoxicillin 1 g BD
Rifabutin‑based therapy
PPI BD
Rifabutin 150 mg BD
Amoxicillin 750 mg TDS
Adjunctive considerations
Avoid alcohol with metronidazole
Avoid macrolides if QT prolongation
Check local resistance patterns
Ensure full 14‑day course
Test‑of‑cure:
Urea breath test OR stool antigen
≥4 weeks after therapy
Stop PPI 2 weeks before
First‑line: Triple Therapy (14 days)
Risk Factors
Childhood exposure
Smoking
NSAID use (synergistic ulcer risk)
Low socioeconomic status
Family history of gastric cancer
Clinical Features
Clinical Features
Dyspepsia symptoms
Epigastric pain
Bloating
Early satiety
Nausea
Ulcer symptoms
Nocturnal pain
Relief with food (duodenal)
Worse with food (gastric)
Alarm features
Weight loss
Anaemia
Dysphagia
GI bleeding
Pathophysiology
Colonisation
Urease production
Converts urea → ammonia
Neutralises gastric acid
Motility
Flagella allow mucosal penetration
Inflammation
Chronic active gastritis
Cytotoxins
CagA
VacA
Disease progression
Duodenal ulcer
Atrophic gastritis
Intestinal metaplasia
Gastric adenocarcinoma
MALT lymphoma
Gastric ulcer
Definition
Gram‑negative spiral bacterium
Microaerophilic
Flagellated
Colonises gastric mucosa
Antrum predominant
Causes chronic gastritis
Transmission
Person‑to‑person
Oral–oral
Faecal–oral
Environmental
Contaminated water
Poor sanitation
Investigations
Non‑invasive
Urea breath test
High sensitivity
Requires stopping PPIs 2 weeks
Stool antigen test
Good for diagnosis & test‑of‑cure
Invasive (endoscopy)
Biopsy urease test (CLO test)
Histology
Culture
Differentials
Dyspepsia causes
Functional dyspepsia
GORD
Peptic ulcer disease (non‑H. pylori)
Gastric cancer
Epigastric pain causes
Pancreatitis
Biliary disease
Complications
Ulcer‑related
Bleeding
Perforation
Gastric outlet obstruction
Cancer‑related
Gastric adenocarcinoma
MALT lymphoma
Prognosis
Good with eradication
Ulcer healing
Reduced cancer risk
Poor if untreated
Progression to atrophic gastritis
Increased malignancy risk
Prevention
Lifestyle
Reduce smoking
Limit NSAIDs
Public health
Improved sanitation
Clean water access
Management
Indications for treatment
Positive test + symptoms
Peptic ulcer disease
Gastric MALT lymphoma
Atrophic gastritis
First‑degree relative with gastric cancer