Case Study 281116 - Persistent H.Pylori Infection

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28 Nov 2016 - General

A middle age lady, with background of hypertension, type 2 diabetes mellitus, peptic ulcer disease, was initially referred for an OGD (gastroscopy), due to increasing epigastric pain that was not improved with proton pump inhibitor, with abdominal bloating, reduced in appetite, and intermiitent feeling of needing extra effort to swallow food (no definite dysphagia). OGD was done showed mild gastritis, and mild duodenitis, with a positive Clo-test. No ulcer seens during the OGD. She was given a course of triple therapy (amoxicillin, clarithromycin, and PPI) for eradication of her Helicobacter Pylori infection. She was followed up in outpatient around 8 weeks after, with persistent symptoms after the course of antibiotic. UBT (urea breath test) was done which showed a positive result. How would you treat her now ?? What potential regimen to use to eradicate the H.Pylori ??

First-line eradication regimens are the following: triple therapy with a PPI, amoxicillin plus imidazole; or PPI, amoxicillin and clarithromycin; or bismuth salts, amoxicillin and imidazole; or sequential therapy. Antibiotic susceptibility testing for clarithromycin is recommended before initial clarithromycin based triple therapy in areas/populations with a known high resistance rate. It is also recommended that the duration of triple therapy be 7 to 14 days. If treatment has failed, there ar...
 (Total 125 words)
Yes, this patient was initially given the first course of triple therapy (amoxicillin, clarithromycin, and a proton pump inhibitor) for the treatment of Helicobacter Pylori, after the OGD/gastroscopy, with the clo-test positive. But, it seems like the initial triple therapy regimen was not successful in treating or eradicating the helicobacter infection. Patient was having persistent upper gastrointestinal symptoms. The Urea Breath Test (UBT) done had confirmed the persistent Helicobacter Infect...
 (Total 105 words)