Often kidney patients come to me with positive HP (Helicobacter pylori) results and ask if they want to take medication to treat it. They are very torn because the specialist doctors must want them to take long-term amoxicillin, clarithromycin and proton pump inhibitors (such as omeprazole, etc.) to prevent excessive stomach acid, which are precisely the drugs that may produce unnecessary kidney damage. Faced with these problems, doctors are also in a dilemma and have to weigh the rights and drawbacks and seek their weight in a dilemma. What is H. pylori? In fact, H. pylori infection is a very common clinical phenomenon, with 50% of the world’s population reportedly carrying H. pylori, and in some regions even 80%. However, only 10% of these carriers suffer from peptic ulcers and only about 1% develop stomach cancer. This means that not all H. pylori are equally pathogenic, for example, in India and surrounding South Asian countries, H. pylori carriage is very high, while the incidence of gastric cancer in these countries is very low. So, H. pylori positive carriage and incidence are completely different things. A central question that arises is whether and how H. pylori needs to be killed? Obvious characteristics of H. pylori H. pylori parasiticus is a Gram-negative bacterium, mainly distributed in the gastric mucosal tissue, 67% ~ 80% of gastric ulcers and 95% of duodenal ulcers are caused by H. pylori. The main symptoms of H. pylori infection are: 1, bad breath: because the bacteria can survive in dental plaque, the infection occurs in the mouth, will directly produce foul-smelling carbons. 2, gastrointestinal disease symptoms: patients with H. pylori infection will appear after meals belching, nausea, bloating, abdominal discomfort gastrointestinal disease symptoms, and these symptoms can occur at any time, but some patients do not have obvious symptoms, only to the hospital to do a relative examination to find. 3.Cancer: With the severity of the disease, it will gradually destroy the wall of the gastrointestinal tract and trigger the occurrence of cancer. Does H. pylori need to be treated or not? For H. pylori is not simply a matter of treatment or not, but requires comprehensive consideration of the patient’s personal conditions, environmental factors, etc. Blind treatment can bring other unnecessary consequences: if it increases the incidence of drug allergy, triggering asthma, dermatitis and purpura in children; it may increase the occurrence of gastroesophageal reflux, the risk of intestinal flora dysbiosis caused by long-term use of antibiotics and the adverse consequences of antibiotic abuse, such as kidney damage. Recommendations The disposition plan for H. pylori infection is as follows (for reference): if HP positive, gastroscopy is recommended and different treatment plans are adopted according to the degree of damage. For those who have undergone gastric cancer surgery, erosion, bleeding, atrophic gastritis, gastroduodenal ulcer or have a family history of gastric cancer, treatment is required if HP is positive. Oral hygiene should be taken care of before eradicating H. pylori. Use mouthwash and antibacterial toothpaste for a period of time to repair oral problems such as tooth decay, tartar, calculus, etc. You can start by replacing dental appliances, not mixing mouth cups, water cups, stainless steel insulated cups, and always steam and sterilize dishes, especially during medication, in separate meals. H. pylori eradication is highly recommended for the following groups of people 1. those suffering from peptic ulcer; 2. those with chronic gastritis and a family history of gastric cancer; 3. those with postoperative gastric cancer and the family members of these people; 4. those suffering from gastric mucosa-associated lymphoid tissue lymphoma. The treatment plan for H. pylori positive includes two major categories 1, is the antibiotic-based program, supplemented with acid inhibitors (bismuth); 2, is the proton pump inhibitor program. Commonly used antibiotics hydroxybenzyl penicillin, gentamicin, clarithromycin and amoxicillin. Patients who need formal treatment should adhere to the medication according to the doctor’s instruction after examination at the hospital and check the efficacy in time.