2025 – PAGE 232 – GASTROENTEROLOGY
HELICOBACTER PYLORI
- PEPTIC ULCER DISEASE (AKA H. pylori induced PUD)
If a patient is diagnosed with an ulcer of any type that is found to be positive for H. pylori, treatment will require a proton pump inhibitor (PPI) and antibiotics. Possible regimens include:
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- PPI + Amoxicillin + Clarithromycin
- PPI + Amoxicillin + Metronidazole (good if the patient can’t tolerate clarithromycin)
- PPI + Clarithromycin + Metronidazole (good if the patient is allergic to penicillin)
- NODULAR GASTRITIS: The most common etiology is H. pylori. An EGD with biopsy (samples sent for pathology) is the gold standard for diagnosis. This can also be found in Crohn’s disease.
- CAMPYLOBACTER-LIKE ORGANISM TEST (AKA CLO test or Rapid Urease Test): Just know that this can be used at the time of an EGD to help diagnose. It’s faster and cheaper than sending a biopsy specimen to pathology, but it is not as specific as an EGD with biopsy.
- UREASE BREATH TEST: This is a noninvasive means to attempt diagnosis of Helicobacter pylori.
- PEARL: If checking for resolution of H. pylori infection, wait at least four weeks after treatment and two weeks after stopping any PPI therapy or you may get a false positive. Use urea breath test or stool antigen test.
NSAID-INDUCED DYSPEPSIA, ULCERS, AND EROSIVE GASTRITIS
NSAID-induced dyspepsia, ulcers, and erosive gastritis result from the inhibition of PGE and thus a decrease in the protection of the gastric mucosa.
PEARL: Especially consider this diagnosis in any patient with a chronic pain illness, such as Sickle Cell Anemia or Juvenile Rheumatoid Arthritis.
EROSIVE GASTRITIS AKA EROSIVE GASTROPATHY
Erosive gastritis (AKA erosive gastropathy) may be caused by NSAIDS, exercise, H. pylori, or the stress of surgery. NSAIDS are the most common cause. “Erosive” refers to mucosal injury. Erosive gastritis and duodenal ulcers may cause black stools!
NON-EROSIVE GASTRITIS
Non-erosive gastritis is associated with Crohn’s Disease, eosinophilic esophagitis and H. pylori. “Non-erosive” refers to the lack of mucosal injury (only erythema is noted on EGD).
NON-ULCER DYSPEPSIA
Non-ulcer dyspepsia is a chronic or recurrent epigastric discomfort associated with early satiety, bloating, belching, nausea, and possibly reflux-like symptoms.
ZOLLINGER-ELLISON SYNDROME
Zollinger-Ellison Syndrome results in multiple GI ulcerations due to a gastrin tumor of the pancreas. Diagnose by checking for a high fasting gastrin level. If diagnosed, you will need to rule out Multiple Endocrine Neoplasia Type 1 (MEN Type 1), which is associated with tumors of the PPP: Pituitary gland, Parathyroid hormones, and Pancreas.