Episode 47. Helicobacter Pylori with Dr Darcy Holt
Helicobacter pylori is a gram-negative curved bacillus that may colonise the gastric and proximal duodenal mucosa. Its significance was first described by Barry Marshall and Robin Warren in 1982 both of whom were awarded the Nobel prize in 2005 after the Nobel community described the discovery as the most impacting in medical sciences. Most medical practitioners are aware of the pathophysiological consequences of Helicobacter which is responsible for gastritis, gastric and duodenal ulcer disease, and may be associated with gastric adenocarcinoma as well as mucosa associated lymphoid tissue hyperplasia (MALT lymphoma). Its eradication has largely hinged on standard triple therapy including a PPI combined with amoxicillin and clarithromycin taken together for 1 week in Australia; unfortunately this regimen has a 10-15% failure rate.
In this episode we are joined today by Dr Darcy Holt, an experienced gastroenterologist to discuss second line treatments that may be considered when first line triple therapy fails.
Darcy covers:
· Current Australian antibiotic guidelines
· Alternate quadruple therapies that are effective in eradication although not subsidised by the PBS at this time
There is a large body of information we cover in this interesting episode, please join me and Darcy.
Maastricht V/Florence Consensus Report recommends:
o Bismuth quadruple therapy for 10-14 days including bismuth subcitrate 120mg qid, tetracycline 500mg qid, metronidazole 400mg tds and PPI bd
o Fluoroquinolone (levofloxacin) 500mg daily, Amoxicillin 1g bd plus PPI standard dose bd (can be converted to quadruple by adding Bismuth 120mg qid or 240mg bd for 10-14 days
o PPI 40mg bd, Bismuth 120mg qid, Tetracycline 500mg qid, Levofloxacin 500mg daily for 10 days (98% effective)
o PPI standard dose qid plus Amoxicillin 750mg bd 14 days – 89% effective
Useful references include:
- www.mja.com.au (MJA 2016:204, 376-380)
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.