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Antimicrobial regimens used in eradication are not without risk for cases of antibiotic-associated (pseudomembraneous) colitis have resulted.

A cautionary note. Helicobacter pylori infection is acquired in early childhood, probably by the faecal-oral route. The prevailing wisdom that 'the only good Helicobacter pylori is a dead Helicobacter pylori' is now tempered by the possibility that the organism (or at least certain subtypes) may perform a useful function. This view is based on evidence that gastro-oesophageal reflux symptoms may sometimes be worsened, and response to proton pump inhibitors diminished, after eradication of Helicobacter pylori. More worrying is the increased incidence of carcinoma at the gastro-oesophageal junction which correlates epidemiologically with reduced prevalence of Helicobacter pylori infection.

In summary, Helicobacter pylori eradication therapy

• indicated for gastric and duodenal ulcer not associated with NSAID use, and gastric lymphoma (especially MALT lymphoma),

• not indicated for reflux oesophagitis, and

• equivocal in value for nonulcer dyspepsia, after incidental detection, and for prophylaxis of gastric cancer.

Some 500 million prescriptions for NSAIDs are written each year in the UK, and 10-15% of patients develop dyspepsia whilst taking these drugs. Gastric erosions develop in up to 80%, but these are usually self-limiting. Gastric or duodenal ulcers occur in 1-5%. The incidence increases sharply with age in those over 60, and the risk of ulcers and their complications is doubled in patients over 75 and those with cardiac failure or a history of peptic ulceration or bleeding. Ibuprofen may be less prone to cause these problems than other NSAIDs.

4 The urea breath test measures radiolabelled C02 in expired air after ingestion of labelled urea, exploiting the fact that the organism produces urease and can convert urea to ammonia.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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