A Journal of the University of Malta Medical School

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Volume 29, Issue 3    (go to table of contents)

Original Article

Rapidity of diagnosis and management of H. Pylori in the endoscopy unit at Mater Dei Hospital

Daniela Zammit, Thelma Xerri, Pierre Ellul

Malta Medical Journal, 2017: 3; 6

Introduction: H.pylori infection has been associated with various gastric pathologies and its prevalence varies between different countries. Furthermore, there is an increasing antibiotic resistance and the eradication rates have declined. There is clinical and administrative pressure as to provide the Rapid Urease Test (RUT) result as quickly as possible and ideally prior to discharge from the endoscopy unit.
Results: A total of 542 patients fulfilled the inclusion criteria. The patient`s mean age was 54.6 years and 52.4% were female. The main clinical indications for an Oesophago-Gastro-Duodenoscopy (OGD) were dyspepsia (44.7%) and GORD (24.5%). The overall positivity rate was 15% of which 8.7% were early positive and 6.3% were late positive. Analysis of patientsí age with RUT positivity revealed that patients above the age of 60 years were more likely to have a positive result (p=0.013). There was no statistical significance between the H.pylori results and smoking (p= 0.6).
In this study, there was a variety of 10 different eradication regimes prescribed, the most popular being the use of a PPI 20mg BD + Amoxicillin 1g BD + Clarithromycin 500mg BD for 10 days (total of 27 cases) versus 14 days (23 cases).
Conclusion: This study demonstrates the importance of checking the RUT taken at endoscopy at 24 hours as this has given a 42% increase in the yield for H.pylori. It also demonstrates that various regimens are used in clinical practice. In view of the relatively low prevalence of H.pylori, especially amongst young patients, maybe it is prime time that treatment of H.pylori is specifically managed by culture and sensitivity to avoid worsening clarithromycin-resistance.

Keywords:

Helicobacter pylori; triple therapy; OGD; Proton Pump Inhibitor; eradication regime.

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