Helicobacter pylori is prone to cause gastric cancer. The following 3 points should be paid attention to in the treatment!

This article is only for medical professionals to read and reference.
Quick collection China is a country with a high incidence of Helicobacter pylori (Hp) infection.
25% to 30% of Hp infected people will have different degrees of gastrointestinal diseases, such as indigestion and chronic gastritis.
, peptic ulcer, etc.
, and Hp infection is also one of the causes of gastric cancer in China
.

How to find out if you have Hp infection? And how to treat it? Conventional methods for diagnosing H.
pylori infection The diagnostic examination methods for H.
pylori infection mainly include: 13C, 14C urea breath test, stool antigen detection, biopsy and other methods (Table 1).
Among them, 13C and 14C urea breath test is non-invasive and highly acceptable.
It is listed as the "gold standard" for the diagnosis of Hp infection in the clinical guidelines of many countries
.

Table 1 Helicobacter pylori inspection methods Note: * Proton pump inhibitors should be stopped for 2 weeks before the test, and antibiotics should be used for 4 weeks after the diagnosis.
How to use the drugs? How long does it take? Hp gastritis is an infectious disease, and it is necessary to treat Hp positive patients
.

According to the "Fifth National Consensus Report on the Treatment of Helicobacter pylori Infection", the recommended empirical bismuth quadruple therapy regimen (bismuth + PPI + antibiotics) is 14 days, with a minimum of 10 days
.

Since the resistance rate (including multi-resistance rate) of clarithromycin, metronidazole and levofloxacin is on the rise, special attention should be paid to the treatment.
Among them, when levofloxacin is used after the first Hp treatment, but the treatment effect is not good, The second treatment should avoid the choice of antibiotics that have been used before
.

The use of antibacterial drugs can refer to Table 2
.

Table 2 Dosage, usage and evaluation of antimicrobial drug combination in quadruple regimen Note: a standard dose of proton pump inhibitor + standard dose of bismuth (2 times a day, orally half an hour before meals) + 2 kinds of antibiotics (oral after meals)
.

Standard-dose proton pump inhibitors are esomeprazole 20 mg, rabeprazole 10 mg (or 20 mg), omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, esomeprazole Prazole 5 mg, choose one of the above; the standard dose of bismuth is bismuth potassium citrate 220 mg (the standard dose of bismuth pectin is to be determined); b curative effect according to Graham grade: C grade is 85%-89%, B grade is 90%~94%
.

when to eat? What are the precautions? Many patients with Hp infection have many doubts, such as: When should we take these medicines? What should I pay attention to while taking the medicine? Stomach medicine (PPI): take 30 minutes before meals to reduce the acidity in the stomach, do not let the stomach acid "digest" the antibacterial drugs; Reduce the acidity in the stomach
.

At the same time, special attention should be paid to the following 3 points when taking drugs: 1.
During treatment, do not drink alcohol
.

2.
The main reason for the failure of H.
pylori eradication is family transmission.
Therefore, family members can be considered for treatment together (children under 14 years old may not need treatment)
.

3.
The drug should be stopped when adverse reactions occur in the treatment of Hp patients.
The specific conditions are shown in Table 3 below
.

However, the drug does not need to be discontinued as tolerated by the patient
.

Table 3 References for common adverse reactions of Hp treatment: [1] Wan Yi, Xu Yongyong, Xue Fubo, et al.
Meta-analysis of Helicobacter pylori infection among genders and families [J].
Chinese Journal of Epidemiology, 2003, 24(1 ): 54-57[2] Helicobacter pylori and peptic ulcer group of Chinese Medical Association Gastroenterology Branch, National Helicobacter pylori Research Collaborative Group, Liu Wenzhong, et al.
The Fifth National Consensus Report on the Management of Helicobacter pylori Infection[J] ].
Chinese Journal of Internal Medicine, 2017, 56(7): 532-545.
[3] Fallone CA, Chiba N, van Zanten SV, et al.
The Toronto consensus for the treatment of Helicobactor pylori infection in adults [J].
Gastroenterology, 2016, 151(1):51-69.
[4]MalfertheinerP,MegraudF,O'MorainCA,et al.
Management of Helicobactor pylori infection—the MaastrichtV/Florence consensus report[J].
Gut,2017,66(1):6- 30.
[5] LiWQ, MaJL, ZhangL, et al.
Effects of Helicobactor pylori treatment on gastric cancer incidence and mortality in subgroups[J/OL].
J Natl Cancer Inst, 2014, 106(7):dju116(2014-01 -12) [2017-04-02].
[6] Chinese Medical Association, Journal of Chinese Medical Association, General Practice Branch of Chinese Medical Association, et al.
Guidelines for primary diagnosis and treatment of Helicobacter pylori infection (2019) [J].
Chinese Journal of General Practitioners, 2020, 19(5) : 397-402.
[7] Adverse Drug Reaction Information Bulletin (Issue 58) Focuses on Serious Adverse Reactions of Fluoroquinolones.
November 21, 2013