Chronic gastric infection causing peptic ulceration, gastric MALT lymphoma and gastric adenocarcinoma.
Investigations
- • Urea breath test or stool antigen (stop PPI 2 weeks, antibiotics 4 weeks before)
- • Biopsy urease test at endoscopy
- • Confirm eradication ≥4 weeks after treatment
Management
- • First-line: PPI BD + amoxicillin 1 g BD + clarithromycin 500 mg BD × 14 days
- • Penicillin allergy: PPI + clarithromycin + metronidazole
- • Quadruple bismuth therapy if high clarithromycin resistance or prior failure
Clinical pearls
- • Always retest after treating ulcer disease or MALT lymphoma
- • Eradication heals most duodenal ulcers without long-term acid suppression
Related in WardRound
Educational — verify locally.
