Treatment and FollowUp

Pharmacological Therapy

PPI are administered. If H. pylori is detected, the following regimen is used for eradication:

1. PPI, for example, pantoprazol, 40 mg 1-0-1

2. Clarithromycin, 500 mg 1-0-1

3. Amoxicillin, 1000 mg 1-0-1

Irritants, nicotine, and NSAIDs should be withdrawn.

Complications

► Oozing hemorrhage

► Massive hemorrhage (treatment, see p. 151 ff.)

► Perforation

► Gastric outlet stenosis

Follow-Ups

Endoscopy is repeated at four to six weeks, and new specimens are obtained. Additional follow-ups are scheduled according to the progression of healing.

Problems

► Refractory ulcer

Fig. 3.88 Gastric ulcer a Ulcer in the antrum

Fig. 3.88 Gastric ulcer a Ulcer in the antrum

Gvhd Colon

b Ulcer with a fibrin coating c Ulcers at the angulus b Ulcer with a fibrin coating c Ulcers at the angulus

Predominantly fibrin-coated ulcer with hematin traces

e Gastric ulcer with a small hemorrhage

TO u

■ Tests for Detection of Helicobacter pylori

Rapid Urease Test Principle ► Based on the ability of the organism to convert urea into carbon dioxide and ammonia. A specimen of mucosa is placed into a test medium that contains urea and an indicator dye. If H. pylori is present, the pH rises, producing a characteristic color change, depending on the indicator used. Sensitivity ► 90-95% Specificity ► 95% Advantages ► Economical

► Fast (15 minutes to three hours) Disadvantages ► Does not indicate degree of inflammation Evaluation ► Fast, simple, low-cost test to detect or exclude H. pylori colonization

Histological Detection

Principle

Sensitivity Specificity Advantages

Disadvantages Evaluation

C13 Breath Test Principle ►

Sensitivity

90%

Specificity

95%

Advantages

Noninvasive

Disadvantages

High cost

Does not indicate degree of inflammation

Evaluation

Ideal for confirming eradication

Serological Testing

Serological Testing

Staining and direct histological identification of the organism in a tissue specimen (Fig. 3.89) 85-95% 95-100% Standard method

Provides information on inflammatory activity Invasive

Standard method

The breath test, like the rapid urease test, is based on the ability of H. pylori to break down urea. The patient consumes a test meal containing C13-labeled urea. The H. pylori urease splits the urea, and C13-labeled carbon dioxide is exhaled. The exhaled air is collected and analyzed by mass or infrared spectroscopy.

Principle

Sensitivity Specificity Advantages Disadvantages

Evaluation

► Serological tests are based on the detection of IgG and IgA antibodies against H. pylori in the serum. High titers of these antibodies are found during or immediately after a florid infection.

► Noninvasive

► Not useful for confirming eradication

► Relatively low sensitivity and specificity

► Does not indicate degree of inflammation

► Very useful for epidemiological studies

► Not useful for planning treatment or evaluating response

Culture Method Principle ►

Evaluation ►

It is possible to culture and identify H. pylori in special laboratories. 70-90% 100%

Can be used to test antibiotic sensitivity

Invasive

Very costly

Relatively low sensitivity

Not a routine method, should be reserved for special investigations

Fig. 3.89 Histological detection of H. pylori a Low-grade, inactive gastritis b With Warthin-Starry staining, even a relatively low-power view shows H. pylori organisms (black) densely colonizing the ridge summits and pit epithelium (from: Hahn and Riemann, Klinische Gastroenterologie. Vol. I, 3 rd ed. Stuttgart: Thieme 1996)

Fig. 3.89 Histological detection of H. pylori a Low-grade, inactive gastritis b With Warthin-Starry staining, even a relatively low-power view shows H. pylori organisms (black) densely colonizing the ridge summits and pit epithelium (from: Hahn and Riemann, Klinische Gastroenterologie. Vol. I, 3 rd ed. Stuttgart: Thieme 1996)

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