the new aga dyspepsia guideline

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U.S. Prevalence of H. pylori . Adapted from H. pylori and Peptic Ulcer. Bethesda, MD: National Digestive Diseases Information Clearinghouse; 1997. NIH publication 97-4225. . . . African AmericanHispanicWhite. . . . Age (years). . . . . . . . 0. 20. 40. 80. 0. 20. 100. Prevalence of H. pylori (%).

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1. The New AGA Dyspepsia Guideline

2. When researchers began to look for H pylori prevalence, they found it was remarkably common. Incidence of H pylori is very high, much higher than the incidence of ulcers. In the United States, incidence is higher among Hispanics and African Americans, approaching 100% in African Americans in the 40- to 60-year-old age group. But obviously, not all these people have ulcers. For many, H pylori may be commensual. In third world countries, H pylori incidence is virtually 100%, and there are relatively few ulcers. It is true that H pylori colonization rises with age and so does peptic ulcer disease (PUD). When researchers began to look for H pylori prevalence, they found it was remarkably common. Incidence of H pylori is very high, much higher than the incidence of ulcers. In the United States, incidence is higher among Hispanics and African Americans, approaching 100% in African Americans in the 40- to 60-year-old age group. But obviously, not all these people have ulcers. For many, H pylori may be commensual. In third world countries, H pylori incidence is virtually 100%, and there are relatively few ulcers. It is true that H pylori colonization rises with age and so does peptic ulcer disease (PUD).

3. H pylori: Disease Progression It is thought that a superficial gastritis caused by H pylori infection leads to further complications. The location in the GI tract where infection is concentrated determines which complications a patient may develop. Patients with H pylori infection in the antral region of the stomach may develop chronic, active, antral gastritis and have an increased risk of developing duodenal ulcer. Patients with H pylori infection concentrated in the stomach corpus may develop chronic, active, corpus gastritis and have an increased risk for developing gastric ulcer. It is thought that a superficial gastritis caused by H pylori infection leads to further complications. The location in the GI tract where infection is concentrated determines which complications a patient may develop. Patients with H pylori infection in the antral region of the stomach may develop chronic, active, antral gastritis and have an increased risk of developing duodenal ulcer. Patients with H pylori infection concentrated in the stomach corpus may develop chronic, active, corpus gastritis and have an increased risk for developing gastric ulcer.

4. Primary Therapy for H. pylori

5. Triple vs. Quadruple Therapy for H. pylori Infection: A Meta-analysis In this multicenter trial from the US and Canada, patients with H. pylori infection were randomized to treatment with PPI-based quadruple therapy using the “single-triple” capsule or to PPI-based triple therapy. The “single-triple” capsule contains bismuth biskalcitrate 140 mg, metronidazole 125 mg and tetracycline 125 mg. Patients randomized to that treatment took three capsules qid with omeprazole 20 mg bid (OBMT).The alternative treatment was omeprazole 20 mg bid with clarithromycin 500 mg bid and amoxicillin 1000 mg bid (OAC) Each regimen was given for 10 days. Overall eradication rates were comparable. OBMT performed well against metronidazole-resistant strains. OAC was significantly less effective against clarithromycin-containing strains than OBMT.In this multicenter trial from the US and Canada, patients with H. pylori infection were randomized to treatment with PPI-based quadruple therapy using the “single-triple” capsule or to PPI-based triple therapy. The “single-triple” capsule contains bismuth biskalcitrate 140 mg, metronidazole 125 mg and tetracycline 125 mg. Patients randomized to that treatment took three capsules qid with omeprazole 20 mg bid (OBMT).The alternative treatment was omeprazole 20 mg bid with clarithromycin 500 mg bid and amoxicillin 1000 mg bid (OAC) Each regimen was given for 10 days. Overall eradication rates were comparable. OBMT performed well against metronidazole-resistant strains. OAC was significantly less effective against clarithromycin-containing strains than OBMT.

6. Effect of Antibiotic Resistance on the Efficacy of First-line H. pylori Therapies In this multicenter trial from the US and Canada, patients with H. pylori infection were randomized to treatment with PPI-based quadruple therapy using the “single-triple” capsule or to PPI-based triple therapy. The “single-triple” capsule contains bismuth biskalcitrate 140 mg, metronidazole 125 mg and tetracycline 125 mg. Patients randomized to that treatment took three capsules qid with omeprazole 20 mg bid (OBMT).The alternative treatment was omeprazole 20 mg bid with clarithromycin 500 mg bid and amoxicillin 1000 mg bid (OAC) Each regimen was given for 10 days. Overall eradication rates were comparable. OBMT performed well against metronidazole-resistant strains. OAC was significantly less effective against clarithromycin-containing strains than OBMT.In this multicenter trial from the US and Canada, patients with H. pylori infection were randomized to treatment with PPI-based quadruple therapy using the “single-triple” capsule or to PPI-based triple therapy. The “single-triple” capsule contains bismuth biskalcitrate 140 mg, metronidazole 125 mg and tetracycline 125 mg. Patients randomized to that treatment took three capsules qid with omeprazole 20 mg bid (OBMT).The alternative treatment was omeprazole 20 mg bid with clarithromycin 500 mg bid and amoxicillin 1000 mg bid (OAC) Each regimen was given for 10 days. Overall eradication rates were comparable. OBMT performed well against metronidazole-resistant strains. OAC was significantly less effective against clarithromycin-containing strains than OBMT.

7. What is Sequential Therapy?

8. Meta-analysis of Sequential vs. Triple Therapy for H. pylori 10 RCTs Publication bias, only 1 DB, most Italian

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