Before commencing with treatment, Helicobacter pylori infection needs to be confirmed by one or more of the following tests :
- stool antigen test
- urea breath test
- serologic assay (blood test)
The aim of treatment is to eradicate the H.pylori infection and allow for the stomach lining to heal to a sufficient extent where the structural integrity can be restored and the natural defences can prevent a re-infection of the area.
Helicobacter pylori is a bacterium and therefore an antibiotic is necessary to eradicate it. However, the H.pylori species has become fairly resistant to antibiotics and two or more antibiotics may need to be used simultaneously. In addition, a drug to reduce acid production will assist with easing the irritation to the stomach lining (gastritis) caused by the stomach acid. This will allow for the inflamed lining or ulcer to heal. The decrease or disappearance of gastritis symptoms after treatment indicates a successful eradication. This can be confirmed with H.pylori status testing after therapy especially in a case of persistent or recurrent symptoms after therapy.
Triple Therapy for H.Pylori Infection
The first line of treatment that is widely used these says is a triple therapy regimen where 3 drugs are used simultaneously. The types of drugs used are as follows :
- One proton pump inhibitor (PPI like lansoprazole or omeprazole) or a bismuth-based drug (like bismuth subsalicylate or rantidine bismuth citrate)
- Two antibiotics simultaneously like clarithromycin and amoxicillin or metronidazole and tetracycline.
The combination of these drugs are prescribed as follows :
- OAC : omeprazole + amoxicillin + clarithromycin
- BMT : bismuth subsalicylate+ metronidazole + tetracycline
- LAC : lansoprazole + amoxicillin + clarithromycin
This treatment usually lasts for 10 to 14 days, although 7 days may be sufficient – this is dependent on regional factors. Following the triple therapy, acid suppressive therapy will be continued for 4 to 12 weeks.
If triple therapy fails, then quadruple therapy (using 4 drugs) is then advisable. This is the second line of treatment for H.pylori gastritis. Acid suppressive therapy may then be followed up for 4 to 12 weeks. The chances of adverse effects are greater with quadruple therapy and it generally has poor patient compliance (meaning that many patients do not see through the entire treatment regimen or take it as prescribed).
Quadruple therapy for H.pylori eradication may include a PPI, bismuth-based drug and two antibiotics used simultaneously. H2-blockers may be included on a daily basis.
Treatment for Other Infectious Gastritis
- Fungal Gastritis
- The treatment for gastritis caused by Candida albicans or disseminated histoplasmosis may include the use of drugs like itraconazole, fluconazole, or amphotericin B.
- Tuberculous Gastritis
- The treatment of tuberculous gastritis consists of daily pyrazinamide, rifampin, and isoniazid for 2 months, followed by 4 months of daily isoniazid and rifampin.
- CMV Gastritis (Phlegmonous Gastritis)
- Medical management with antiviral therapy for cytomegalovirus (CMV) infection is not very effective. Surgical resection of the affected area of the stomach is considered as the most effective treatment.