debate re what best test

• prevalence in NZ lower than many other developed conutnries

• \~18.6% in south auckland

• NZ euro = 7/7%

• usually acquired in childhood and doesen’t usually resolve spontaneously

Testing

routinely testing all paitents with dyspeptic symptoms for H.pylori or prescribing epmpiric eradication rx wihotu testing not recommended

Red flags

• age ≥ 50yo @ first presentation

• age ≥ 40yo maori/pi / asian

• FHx onset \<50yo of gastric caner

• Severe/persistent

• previous history of PUD

• Apsirin/nsaid

• signs and symptoms of chronic GI bleeding

• iron def. anaemia

• difficulty swallowing

• persistent regurgitation or protracted vomiting

• palpable abdominal mass

• unexplained weight loss

Low risk

• PPI and review in 1/12

High risk

• faecal antigen test

  • eradication treatment

Testing

Faecal antigen

sens = 94-05%; Spec 94-97%; PPV 84%

• Tier 1 test

• presence of antigens to Hpylori in faecal sample

• used to diagnose active infection

• confirm eradication

• Sens and spec similar for carbon-13 urea breath test

• false negative

  • taking medications decrease load of h.pylori

  • (PPI)

Carbon -13 urea breath testing

sens 95%; Spec 96%; PPV 88%

• gold standard

• test time consuming

• expensive

• not funded in NZ

• false neg with PPI

Serology

sens 85-92%; 79-83%; PPV 64%

• no longer funded

• cannot distinguish between infection that is past or current

• cannot be used as test of cure

Eradication

• triple treatment regime

• 7 day course

• Omeprazole 20mg bd

• Clarithromycin 500mg bd and

• Amoxicillin 1g bd (or metronidazole 400mg bd)

confirmation of eradication not requried

If failure

• 14d quadruple therapy

• Omeprazole 20mg bd

• tripotassium dicitratobismuthate 129mg qds

  • one dose 30 mins before each meal and one dose 2 hours after evening meal

• Tetracycline HCl 500mg qds

• Metronidazole 400mg tds

• tripostssium and tetracycline section 29

• doxyccyline not recommended

  • significantly lower eradication