Hi. I'm Dr. Amy Oxentenko. I'm here today to talk about a paper that I recently published with two of my colleagues Dr. Amrit Kamboj as well as Dr. Thomas Cotter on Helicobacter pylori infection. So one of the reasons that we decided to write this review is that Helicobacter pylori infection is very common and in fact is one of the most common infections that we see worldwide. As a gastroenterologist and as primary care physicians this is something that we deal with regularly in our office because it's the most common cause aside from NSAID therapy in courten causing peptic ulcer disease.

We know that Helicobacter pylori infection can cause only peptic ulcer disease but dyspeptic symptoms in some patients and in a small percentage of patients can lead to gastric cancer or gastric lymphoma. We can diagnose h pylori infection through a variety of modalities including stool studies breath tests or more invasive studies such as with an EGD where we might take biopsies or do special tests on tissue sampling from the stomach mucosa.

Most patients that can be diagnosed with Helicobacter pylori through non-invasive means and that means either through a stool test or an in-office breath test and both of those tests will determine active infection and I think that's really important because there is a blood test for Helicobacter pylori infection but that does not test active infection that tests whether you've ever had Helicobacter pylori infection so it's not a great marker of active disease and so we've really stopped using that as commonly in our clinical practice.

Once someone has been diagnosed with Helicobacter pylori really the important focus in today's stage day and age is determining the best therapy for that Helicobacter pylori infection because we want to do whatever we can to achieve the best eradication rates. What's happened over time is our success in eradicating Helicobacter pylori infection in any individual has decreased over time and that is because the bacteria has become more resistant to certain antibiotics and specifically clarithromycin which was one of the key antibiotics that we've always used to treat this infection has had growing levels of resistance which means that more and more patients have a type of Helicobacter pylori that will not respond to clarithromycin therapy. Because of this what we see is we have more and more patients that are not eradicated once we've done what we think would be successful therapy for them requiring us to retreat them with another course of an antibiotic regimen.

So when we're making a decision of what to treat a patient with a few things are taken into consideration. First we look at a patient's allergies to make sure they're not allergic to penicillin because amoxicillin is one of the antibiotics that are commonly used in some of the therapies for Helicobacter pylori infection. The other thing to consider is whether a patient has either lived in an area where there's high clarithromycin resistance but also have they been exposed to antibiotics that contain clarithromycin type antibiotics because if that is the case they are more likely to have resistant Helicobacter pylori infection that may not respond to a clarithromycin based regimen.

So new guidelines have come out in recent years suggesting that some of the tried-and-true quadruple therapies which include a proton pump inhibitor metronidazole tetracycline and pepto-bismol or bismuth therapy is probably one of the most helpful therapies in terms of giving you successful eradication. Once we've treated a patient and oftentimes we will treat them for up to 14 days in order to achieve the best eradication rates that we can we want to make sure that we have eradicated the bacteria fully. In order to do this we typically will do testing no sooner than four weeks after the completion of therapy typically again that can be done with either an in-office breath test or a stool test both of which will show if there's active Helicobacter pylori infection still present or not. If it is still present than an alternative course of retreatment would be recommended again assessing for eradication after the completion of that subsequent therapy.

So I hope this has been a helpful review knowing that Helicobacter pylori infection is a common infection can lead to peptic ulcer disease most commonly but rarely can lead to malignant complications such as lymphoma and gastric cancer. Because of those things it's really important that we not only treat it effectively but make sure that we've treated it successfully in all patients who undergo Helicobacter pylori therapy. Thank you.