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Question 7#

A 36-year-old man presents for a well-patient examination. He gives a history that, over the past 20 years, he has had three episodes of abdominal pain and hematemesis, the most recent of which occurred several years ago. He was told that an ulcer was seen on a barium upper GI radiograph. You obtain a serum assay for H pylori IgG, which is positive.

What is the most effective regimen to eradicate this organism?

a. Omeprazole 20 mg orally once daily for 6 weeks
b. Ranitidine 300 mg orally once daily at bedtime for 6 weeks
c. Omeprazole 20 mg twice daily, amoxicillin 1000 mg twice daily, and clarithromycin 500 mg twice daily for 14 days
d. Bismuth subsalicylate and metronidazole twice daily for 7 days
e. Benzathine penicillin, 1.2 million units intramuscularly weekly for three doses

Correct Answer is C

Comment:

Although acid suppression therapy leads to 80% healing rates after 4 weeks of treatment, acid reduction with omeprazole or ranitidine alone does not eradicate H pylori. Three- or four-drug therapy, including bismuth or (most often) proton pump inhibitor, combined with two antibiotics effective against H pylori, will be necessary to eradicate the organism. Longer duration of therapy (ie, 14 days) leads to a greater healing rate. This regimen will eradicate H pylori in more than 90% of patients. Patients whose H pylori has been eradicated have only a 5% chance of ulcer recurrence (compared to 60%-70% of patients not treated for H pylori). Follow-up tests to prove H pylori eradication are not recommended in the usual patient who becomes asymptomatic. If the peptic ulcer should recur (again, this happens infrequently), either direct testing of a biopsy specimen or a test for urease activity in the stomach is necessary, as the serological studies remain positive for many years. Benzathine penicillin is commonly used to treat syphilis but not Helicobacter.