H. pylori Treatment and Acid Suppression

Treatment of H. pylori Infection

• Treatment involves a combination of antibacterial drugs, typically for 10-14 days
• First-line treatment options include Clarithromycin triple or Bismuth quadruple therapy
• Second-line treatment option is Levofloxacin triple therapy
• Third-line treatment option is Rifaputin triple therapy
• Choice of regimen depends on previous treatment with clarithromycin, penicillin sensitivity, cost, and adverse effects

Suppression of Acid Secretion

• Histamine H2-antagonists, such as Cimetidine and Ranitidine, inhibit the parietal cell H2 receptor, especially effective in inhibiting nocturnal acid secretion
• Proton pump inhibitors (PPIs), such as Omeprazole and Pantoprazole, irreversibly inhibit H+/K+-ATPase, the last step of forming HCl

Protective Agents

• Sucralfate, Misopristol, and Bismuth form a protective barrier on epithelial cells

Diagnosis of H. pylori Infection

• Diagnosis involves endoscopy, serological tests, and urea breath test

H. pylori Treatment

• Approximately 90% of patients with duodenal ulcer are infected with H. pylori, diagnosed by endoscopy, serological, and urea breath test.
• Eradication of H. pylori prevents mucosal injury, reduces inflammation, and treats conditions like duodenal ulcer, non-ulcer dyspepsia, and prevents bleeding from stress-related gastritis.

Treatment Regimens

• First-line treatment: Clarithromycin triple or Bismuth quadruple (10-14 days).
• Second-line treatment: Levofloxacin triple.
• Third-line treatment: Rifaputin triple.
• Choice of regimen depends on previous treatment with clarithromycin, penicillin sensitivity, cost, and adverse effects.

Drug Interactions and Side Effects

• H. pylori treatment can interact with several drugs, including Tetracyclines, iron, fluoroquinolones, digoxin, phenytoin, chlorpromazine, and isoniazid.
• Carbonates can cause flatulence and bloating due to CO2 release.
• Antacids and drugs for diarrhea have side effects, including drowsiness, abdominal cramps, dizziness, and constipation.
• Toxic megacolon is a concern, and these drugs should not be used in young children.

Approaches to Diarrhea Treatment

• There are three approaches to treating severe acute diarrhea.

Diagnosis of H. Pylori

• H. Pylori is diagnosed by endoscopy, serological, and urea breath test

Treatment of H. Pylori

• First-line treatment: Clarithromycin triple or Bismuth quadruple (10-14 days)
• Second-line treatment: Levofloxacin triple
• Third-line treatment: Rifaputin triple
• Choice of regimen depends on previous treatment with clarithromycin, penicillin sensitivity, cost, and adverse effects

H2 Antagonists

• Have a modest impact on meal-stimulated acid secretion (stimulated by gastrin, acetylcholine, and histamine)
• Inhibit 60-70% of total 24-hour acid secretion
• Largely replaced by proton pump inhibitors (PPIs)

Proton Pump Inhibitors (PPIs)

• Effective in GERD and uncomplicated PUD (treatment for 6-8 weeks)
• PPIs are preferred over H2 antagonists

Antimotility Agents

• Example: Loperamide
• Activates presynaptic opioid receptors in the enteric nervous system, inhibiting acetylcholine release and decreasing peristalsis
• Does not cross the blood-brain barrier (BBB)
• Side effects: Drowsiness, abdominal cramps, dizziness, constipation
• Contraindicated in young children due to risk of toxic megacolon

H2 Antagonists

• Modest impact on meal-stimulated acid secretion, which is stimulated by gastrin, acetylcholine, and histamine
• Inhibit 60-70% of total 24-hour acid secretion
• Largely replaced by proton pump inhibitors (PPIs)

Proton Pump Inhibitors (PPIs)

• Examples: Omeprazole, Pantoprazole
• Prodrugs that irreversibly inhibit H+/K+-ATPase, the last step of forming HCl
• Can interact with several drugs, such as Tetracyclines, iron, fluoroquinolones, digoxin, phenytoin, chlorpromazine, isoniazid, etc.

Antacids

• Can cause flatulence and bloating due to CO2 release

Diarrhea Treatment

• Three approaches to treatment:
  • Maintenance of fluid and electrolyte balance
  • Use of anti-infective agents (e.g., Azithromycin or ciprofloxacin for bacterial infections, Metronidazole for giardia and amoeba infections)
• Side effects of treatment: drowsiness, abdominal cramps, dizziness, constipation
• Contraindication: toxic megacolon, should not be used in young children