How to eradicate Helicobacter pylori

Written by Huang Ya Juan
Gastroenterology
Updated on September 19, 2024
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The spontaneous clearance rate of Helicobacter pylori infection is extremely low, meaning that it is almost impossible to cure itself. If not treated medically, it may lead to a lifelong infection. Currently, the consensus both domestically and internationally on handling Helicobacter pylori is that eradication requires combination therapy with multiple drugs, categorized into triple therapy and quadruple therapy, with a treatment duration of 2 weeks. Triple therapy consists of a proton pump inhibitor (PPI) plus two antibiotics. We currently use quadruple therapy, which includes two antibiotics, a gastric mucosal protectant, and a proton pump inhibitor. The choice of these drugs is complex. Common anti-inflammatory drugs include amoxicillin, clarithromycin, metronidazole, and levofloxacin; in cases of bacterial resistance, we recommend using furazolidone or tetracycline. Specific medications should be consulted in detail with a doctor. After the treatment course, we need to assess whether the eradication was successful, with a re-examination one month after stopping the drugs. After the eradication of Helicobacter pylori, the rate of reinfection in adults is very low, but the reinfection rate in children is somewhat higher than in adults. Not everyone infected with Helicobacter pylori needs eradication; it is necessary only for those with ulcers, erosion, atrophy, or related symptoms.

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Written by Peng Miao Yun
Internal Medicine
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What should I do if I have a Helicobacter pylori infection?

Helicobacter pylori is closely related to the occurrence of chronic gastritis, gastric ulcers, and gastric cancer, but not everyone infected with Helicobacter pylori will develop chronic gastritis or gastric ulcers. Infections can be diagnosed with a breath test, where values more than twice the normal level, accompanied by symptoms of gastritis, gastric ulcers, stomach distension, stomach pain, and acid reflux, should be considered for antibacterial and stomach-protective treatment. Generally, with standard treatment, 90% of Helicobacter pylori can be eradicated within one to two weeks. However, reinfection is common as it can be found in food and utensils and transmitted through saliva. It is generally advised that children under 14 and individuals with low levels of Helicobacter pylori without obvious stomach inflammation symptoms do not require immediate treatment.

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Written by Wu Hai Wu
Gastroenterology
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Can treatment for Helicobacter pylori be stopped at any time?

During the treatment of Helicobacter pylori, it is not advisable to stop the medication arbitrarily, as doing so may lead to insufficient treatment duration and result in a failure to eradicate the bacteria. Therefore, it is recommended to use a bismuth-containing quadruple therapy for two weeks to eradicate Helicobacter pylori. The specific medications included in this two-week quadruple therapy are a proton pump inhibitor such as pantoprazole or lansoprazole, plus two antibiotics such as amoxicillin, clarithromycin, or metronidazole, combined with bismuth potassium citrate. The medication should be taken under medical supervision. Helicobacter pylori infection can be detected through a carbon-13 breath test or a carbon-14 breath test.

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Written by Jiang Guo Ming
Gastroenterology
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Do normal people have Helicobacter pylori?

In my understanding, a “normal person” refers to individuals who do not experience any stomach discomfort. In our country, the infection rate of Helicobacter pylori is extremely high, with reports indicating that over 50% of adults are infected, albeit asymptomatically. Thus, it is certain that many so-called "normal people" are infected with Helicobacter pylori, also known as asymptomatic Helicobacter pylori carriers. This condition also requires antibacterial treatment because there is a close relationship between Helicobacter pylori and gastritis, ulcers, and gastric cancer. Even for patients with chronic superficial gastritis, if Helicobacter pylori is present, eradication therapy is advocated. If not completely eradicated, it often leads to the development of chronic atrophic gastritis, which is a more serious condition.

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Written by Wu Hai Wu
Gastroenterology
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Is the treatment process for Helicobacter pylori uncomfortable?

The treatment process for Helicobacter pylori infection is not uncomfortable, primarily involving oral medication. Treatment options include a combination of two antibiotics such as amoxicillin, clarithromycin, furazolidone, metronidazole, etc., alongside a proton pump inhibitor like omeprazole, pantoprazole, or lansoprazole, and the addition of bismuth citrate. This forms a quadruple therapy administered over two weeks to eradicate the infection. During treatment for Helicobacter pylori infection, it is advised to consume a diet rich in vitamins, incorporating fresh vegetables and fruits. It is important to eat regularly, avoid overeating or consuming oily, spicy, and irritating foods. (Please follow medical advice when using medications.)

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Written by Wang Hui Jie
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Can gastroscopy detect Helicobacter pylori?

Helicobacter pylori is a type of bacterium, hence it is invisible to the naked eye. However, during a gastroscopy, the gastroenterologist can infer whether a patient is infected with Helicobacter pylori by observing the mucosal appearance under the endoscope. For example, signs such as the disappearance of damages in the tiny veins, nodular changes resembling chicken skin, scattered congested spots, and others. To confirm the presence of a Helicobacter pylori infection, further tests are required. For instance, during a gastroscopy, a rapid urease test can be conducted where a tissue sample from the stomach is tested - this method is quite convenient. Alternatively, a tissue sample can be sent for pathological examination, which might take longer.