Review Question - QID 107883

This patient presents with H. pylori gastritis complicated by a peptic ulcer. Treatment for H. pylori is with triple or quadruple therapy. Omeprazole, metronidazole, tetracyline, and bismuth is an appropriate quadruple therapy.

H. pylori is a spiral-shaped, gram-negative bacterium that is fastidious to culture. First discovered in the 1980s, it has since been recognized as the leading cause of peptic and duodenal ulcers, as well as a prevalent cause of chronic gastritis and gastric adenocarcinoma and lymphoma. Diagnosis of the bacterium can be accomplished via breath urease test, serology, stool antigen assays, or through endoscopic biopsy with histology. Empiric antisecretory therapy in patients with dyspepsia and acid reflux with proton-pump inhibitors (PPI) is appropriate in areas with a low prevalence of H. pylori infection (< 5%). Definitive diagnosis is required in order to treat for H. pylori infection.

Figure A shows characteristic EGD findings of a peptic ulcer. Figure B shows a biopsy with Warthin-Starry staining for H. pylori. Avid staining by helical bacterium are visualized at mucosal surface.

Incorrect Answers:
Answer 2: Omeprazole, penicillin, ranitidine is not a treatment regimen for H. pylori infection
Answer 3: Although amoxicillin and clarithromycin is an appropriate antibiotic regimen, this combination requires a PPI such as omeprazole
Answer 4: Pantoprazole is a PPI, alone it will not eradicate H. pylori
Answer 5: Pantoprazole and levofloxacin is not a treatment regimen for H. pylori; the combination requires the addition of amoxicillin for effective triple therapy.