Routes of H. pylori transmission
The route of transmission of H. pylori is such that there is a significant clustering of the infection within the family, with the children of infected parents having a much higher chance of infection than other families. H. pylori is widely present in the saliva and dental plaque of infected individuals. Contact with the saliva of infected people, eating food contaminated with H. pylori can cause infection, for example, sharing utensils, mothers chewing food and then feeding it to their babies, and even deep kissing with infected people can also cause infection. H. pylori disease is an acquired infection. In addition, washing hands before meals and after defecation is a way to reduce transmission via the fecal-oral route. If you are found to be infected, the chances of infection in your family members also increase. Once it is confirmed that a family member also has H. pylori infection, they can be treated at the same time if necessary.
The following HP testing methods are commonly used.
1.Mucosal tissue staining
Gastric mucosa tissue section, HE staining can also be used, this method to detect Hp positive rate is high, positive indicates the presence of Hp in the gastric mucosa.
2. Urease rapid test
The gastric mucosa biopsy is put into the urea solution with the indicator phenol red, if there is Hp in the gastric mucosa, the urease secreted by Hp decomposes urea and produces NH3, the latter makes phenol red turn red, this method is simple and positive, it is initially determined that there is Hp in the gastric mucosa, but other methods are needed to confirm.
3.Serum Hp antibody assay
It is an indirect method to check Hp infection, positive indicates that the subject is infected with Hp, but does not indicate the presence of Hp, can not be used as a test to determine the eradication of H. pylori, the most suitable for epidemiological investigation.
4.Urea breath test
It is a non-invasive diagnostic method, oral administration of 14C or 14C-labeled urea, which is hydrolyzed to CO2 by urease produced by Hp on the gastric mucosa and excreted from the lungs, a positive result indicates the current presence of Hp infection, and the result is accurate.
5, Biopsy H. pylori culture (isolated culture method)
Isolation and culture from gastric mucosal biopsy specimens to obtain pure bacteria, and then identified by morphological and biochemical methods, which is the “gold standard” for the diagnosis of Hp infection, but requires certain anaerobic culture conditions and techniques, and is not easy to promote as a routine diagnostic tool.
Safety of urea [14C] breath test
Urea [14C] breath test is safe for both patients and operators
The urea [14C] breath test has been in clinical use for more than a decade and no adverse effects have been reported. To date, all professional assessments of the safety of the urea [14C] breath test have reported negligible radiation risk to patients and operators.
This is based on the following reasons.
1. The radiation energy of 14C is extremely weak, and the low-energy pure beta radiation it releases penetrates so weakly that 0.3 mm of water or a piece of paper (capsule) can block it.
2, 14C-UBT use of urea [14C] physical dose can not be counted, radioactive dose of 0.75-1.00µCi, do a checkup irradiation dose is less than a day of natural background irradiation dose or equivalent to take a one-hour air travel by radiation, or even only equivalent to play a cell phone, its radiation can be almost negligible, it can be seen that its harm is small. Natural radiation is a universal phenomenon, 14C in nature is widespread, in our surrounding air, soil, water, plants and animals, and even people themselves contain natural 14C, terrestrial biology, including people, 14C per gram of carbon is 13.6dpm, the total amount of 14C in adults is 20,000dpm ~ 30,000dpm. and urea [14C] breath test diagnosis In the urea [14C] breath test diagnosis, the strong positive breath sample generally contains only about 3,000 dpm of 14C, which shows that its safety is not in doubt.
3, the biological half-life of urea [14C] is very short, although the physical half-life of 14C is as long as 5730 years, but the biological half-life of urea [14C] is very short, urea form and CO2 form is the ultimate product of human metabolism, the urea that has not been decomposed is excreted from the urine in its original form, the ingested 14C will not be transformed into a part of human muscle, and can be basically excreted from the body in 48 hours, so it will not cause long-term effects on people. Long-term effects.
Indications for H. pylori eradication treatment
I. Indications for HP eradication treatment
1.Peptic ulcer
2.Gastric mucosa-associated lymphoid tissue-like lymphoma
3.HP-positive chronic gastritis with dyspepsia
4, chronic gastritis with mucosal atrophy and erosion: repeated erosion → atrophy, intestinal metaplasia → gastric Ca
5.Early gastric tumor with endoscopic resection or surgical gastric subtotal resection
6.Need to take PPI for a long time
7.Family history of gastric Ca
8.Planned long-term use of non-steroidal antipyretic and anti-inflammatory drugs
9.Other: HP associated with unexplained iron deficiency anemia
10.Personal request for treatment
II. Treatment
1, drug resistance: recommended six antibacterial drugs metronidazole 60 to 70%, Clara 20 to 38%, levoxyl 30 to 38%. Amoxicillin, furan, tetracycline resistance is low (1% to 5%)
2.The standard triple cure rate is lower than 80%: PPI+clar + amox or metronidazole, even if the course of treatment is extended from 7d to 14d, it is only 5% higher.
3.New international recommended radical treatment program in China
Sequential treatment: PPI + amoxicillin for the first 5 d, PPI + clara + metronidazole for the last 5 d
Concomitant therapy: PPI+clar+amoxicillin+metronidazole taken simultaneously
According to our data, sequential therapy has no advantage, and concomitant therapy is comparable to “bismuth quadruple therapy” in China, unless bismuth is contraindicated, concomitant therapy is not recommended.
4, HP high drug resistance background, bismuth quadruple program again attracted attention.
Classic quadruplex: (bismuth + PPI) + tetracycline + metronidazole
2012 Consensus: First-line “bismuth quadruple” is preferred in areas with high resistance to Clara
In the area of low resistance to Clara, in addition to the standard triplet, bismuth quadruplet is also recommended as the first line
5.Safety of bismuth: short-term administration (1 to 2 weeks) is safer, but pay attention to dose, duration and contraindications
6, anti-HP antibacterial drug selection.
Clara, metronidazole and levoxyl are not repeated in principle; amoxicillin, furan and tetracycline can be repeated.
Bismuth, PPI and antibacterial drugs together can overcome HP resistance.
7.Classic “bismuth quadruple” expansion program
(bismuth + PPI) + amoxicillin + clara or furan or FQns
The 14-day regimen can largely overcome the resistance to clara; bismuth + PPI + amox + FQNS
8, penicillin allergy: Clara + levoxyl or furan or metronidazole; tetracycline + furan or metronidazole
9.Course of treatment: 10d or 14d, give up 7 days
10.Review: 1 month after stopping the drug
11.Remedial treatment: 2 to 3 months interval