Management of Helicobacter pylori

Helicobacter pylori (H. pylori) is a bacterium colonising the gastric mucosa and may be the causative agent in a number of gastrointestinal pathologies.

Eradication – which patients?

All patients with proven duodenal ulcers.
Patients with gastric ulcer.
Patients with H. pylori and a strong family history of gastric cancer.
Patients with epigastric pain in the absence of an ulcer.

Assessment / monitoring

Initial testing for H. pylori may be done by laboratory-based serology or stool antigen test.

Drug therapy

One week therapy with a proton pump inhibitor (PPI) and two antibiotics is recommended:

Omeprazole oral 20mg twice daily (or lansoprazole oral 30mg twice daily)

and

Clarithromycin oral 500mg twice daily

and

Amoxicillin oral 1g twice daily.

If penicillin allergy, then prescribe PPI as above as well as:

Clarithromycin oral 500mg twice daily

and

Metronidazole oral 400mg twice daily.

Patients should be counselled on the importance of compliance before starting treatment and in those patients taking metronidazole on the avoidance of alcohol because of the risk of a disulfiram-like reaction.
After 1 week's treatment all medication can be stopped, except where ulcers have bled or perforated, when a PPI will be continued.

N.B. Healing of gastric ulcers must be confirmed by endoscopy after 6 – 8 weeks.

Guideline reviewed: November 2022

Page last updated: December 2022