A 47-year-old man presents for follow up of his previous visit 2 weeks ago, when he was seen for evaluation of his duodenal ulcer. At that time, a test for Helicobacter pylori was performed. The patient was otherwise well but had been complaining of epigastric pain that was exacerbated by eating. An esophageal-gastroduodenoscopy revealed the presence of a duodenal ulcer, and biopsies were taken at that time. In addition, the patient was told that he needed to modify his diet, such as decreasing his coffee intake, and cutting his tobacco use. The patient returns today to discuss his test results, which were positive for the H. pylori organism. Which of the following is the most appropriate therapy at this time?
A. Amoxicillin orally
B. Bismuth, metronidazole, tetracycline, and omeprazole orally
C. Metronidazole orally
D. Omeprazole orally
E. Sucralfate orally
Explanation: The correct answer is B.Helicobacter pylori plays a major role in the pathogenesis of peptic ulcer disease. The organism is present in 95% to 100% of patients with duodenal ulcers and in 75% to 85% of those with gastric ulcers. Eradicating the organism generally results in a cure for the disease. Therapy varies, but one of the more common regimens consists of antibiotics and a proton-pump inhibitor.
Oral amoxicillin (choice A) and oral metronidazole (choice C) are possible antibiotics used in combination therapy. They are not efficacious when given without the other agents in the combination.
The same is true for oral omeprazole (choice D). This proton-pump inhibitor is not efficacious in eradicating the organism when it is given without antibiotics.
Oral sucralfate (choice E) has no role in therapy of H. pylori infection. This drug coats preexisting gastric erosions to prevent worsening of ulcers, not to prevent acid secretion.