Question

J.V., a 56-year-old delivery truck driver, has been taken to the emergency department (ED) because he was experiencing chest pain. It started just after he had a quick lunch at a food truck. He told the paramedic that he often has chest pain but that it goes away when he "takes a swig of antacid," but this time the pain did not stop. On arrival he was given another dose of antacid and sublingual nitroglycerin, and the chest pain stopped. The first set of cardiac enzymes and basic metabolic profile (BMP) were drawn, and a 12-lead ECG was done. He weighs 275 pounds (125 kg), is 5 ft, 5 inches (165 cm) tall, and tells the nurse he has been overweight all his life. He said he'd had the chest pains for about 2 years but did not go to get checked because they always went away when he took antacids and he was too busy with work to go to a doctor. He works late hours, "lives on coffee," and grabs fast food when he has time to eat. He smokes 1.5 to 2 packs of cigarettes a day, has a beer every evening once he is home, and usually finishes a 6 pack on the weekends. Vital signs: T 98.9o F (37.2o C), P 110, R 14, BP 148/98. The test results are listed below.

TEST RESULTS

Sodium: 142 mEq/L (142 mmol/L)     Potassium: 4.1 mEq/L (4.1 mmol/L)

Chloride: 102 mEq/L (102 mmol/L)     CO2: 28 mEq/L (28 mmol/L)

Glucose: 168 mg/dL (9.3 mmol/L)     BUN: 12 mg/dL (4.3 mmol/L)

Creatinine: 1.1 mg/dL (97 mcmol/L)     Calcium: 5.1 mg/dL (1.28 mmol/L)

Hemoglobin: 14.8 g/dL (148 g/L)     Hematocrit: 48%

Cardiac troponin T: 0.05 ng/mL (0.05 mcg/L)     12-Lead ECG: Sinus tachycardia, rate 105

After noting the ECG results and the normal second set of cardiac enzymes, the ED provider tells J.V. that the “chest pain” was more likely gastrointestinal (GI) in origin. J.V. was discharged from the ED with a referral to the hospital’s GI clinic with a possible diagnosis of GERD. One week later, at the GI clinic, he is examined by the GI nurse practitioner (NP). The NP tells J.V. that she thinks he has GERD, but the diagnosis will be confirmed by an upper endoscopic examination. The upper endoscopy is scheduled for 0700 on Tuesday of the following week.

The upper endoscopy is performed successfully. The gastroenterologist tells J.V. and his daughter that the GERD diagnosis is confirmed, and that he has severe esophageal erosion but no visible ulcers. In addition, a gastric mucosal biopsy was sent for Helicobacter pylori. His procedure blood glucose level was 122 mg/dL.

What is H. pylori, and how is it treated?

Answer 1

H.pylori( Helicobacter pylori) is a gram negative bacillus that damages the mucosal membrane leading to cause gastric and duodenal ulcers and also plays an important role in the development of gastritis, gastric adenocarcinoma, Gastrointestinal Reflex Disorder ( GERD) and dyspepsia.

Medicinal treatment of H.pylori infections :-

In most of the cases Triple or quadruple therapy is recommended which includes :-

a) Omeprazole ( 20mg BID) or Lansoprazole ( 30mg BID) + Clarithromycin( 500 mg BID) +Metronidazole ( 500 mg BID) for 14 days.

b) Omeprazole ( 20 mg BID) or Lansoprazole (30mg BID) +Clarithromycin (500 mg BID) + Amoxicillin ( 1 g BID) for 14 days.

c) Omeprazole ( 20 mg OD) or Lansoprazole ( 30 mg BID) +Bismuth subsalicylate (525 mg QID) + Metronidazole ( 250 mg QID) + Tetracycline ( 500 mg QID) for 14 days