Duodenal Ulcers: Concerns About H. Pylori and Treatment Options

Q: Duodenal Ulcers: Concerns About H. Pylori and Treatment Options

Hello： It is recommended to stop the medication for at least one week before undergoing the carbon-13 test. <br>There are many factors that can cause duodenal ulcers, and it is less common to assess severity based on the presence of Helicobacter pylori. <br>Changhua Hospital care

Duodenal ulcer

Hello Dr.
Tsai,
After undergoing an upper gastrointestinal endoscopy, the physician indicated that I have a mild duodenal ulcer, with several small lesions approximately 0.05 cm in size.
There is no Helicobacter pylori infection.
The doctor prescribed me Nizatidine for one month, with a planned treatment duration of two months.
Typically, 90-100% of patients with duodenal ulcers are associated with Helicobacter pylori infection.
Treating the duodenal ulcer while also eradicating Helicobacter pylori can significantly reduce the recurrence rate of the ulcer to below 20%, with most cases being 0%.
Therefore, I am concerned that if there is an undetected Helicobacter pylori infection, even if the treatment is successful, the ulcer may recur and lead to serious complications.
Consequently, before taking a proton pump inhibitor (PPI), I would like to self-fund a carbon-13 urea breath test to confirm the presence of Helicobacter pylori.
My reasoning is that a duodenal ulcer is much more serious than a duodenal ulcer combined with Helicobacter pylori (for the reasons mentioned above).
I am unsure if my understanding is correct.
Additionally, I have another question: will the medications Alginic Acid (Algitab) and Cimetidine 300 mg affect the accuracy of the carbon-13 urea breath test? If so, how long should I wait after taking these medications before undergoing the carbon-13 test?
Thank you for your response.

Emma, 30~39 year old female. Ask Date: 2016/03/24

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: It is recommended to stop the medication for at least one week before undergoing the carbon-13 test.
There are many factors that can cause duodenal ulcers, and it is less common to assess severity based on the presence of Helicobacter pylori.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2016/03/24

More Info

Understanding duodenal ulcers and their association with Helicobacter pylori (H. pylori) is crucial for effective treatment and management. Your concerns about the potential for undetected H. pylori infection and its implications for ulcer recurrence are valid and reflect a common apprehension among patients diagnosed with duodenal ulcers.

Duodenal ulcers are indeed frequently associated with H. pylori infection, with studies indicating that about 90-100% of duodenal ulcer patients have this bacterium present. H. pylori is a gram-negative bacterium that can cause chronic inflammation of the stomach lining (chronic gastritis) and is a significant risk factor for the development of peptic ulcers. The standard treatment for duodenal ulcers typically includes a combination of proton pump inhibitors (PPIs) and antibiotics to eradicate H. pylori, which significantly reduces the risk of ulcer recurrence.

In your case, since your doctor has indicated that you do not have H. pylori, it is essential to consider the possibility of false negatives, especially if the testing was not comprehensive or if the infection was intermittent. Your plan to undergo a carbon-13 urea breath test (C13 breath test) is a reasonable approach to confirm the absence of H. pylori before proceeding with further treatment. This non-invasive test is highly sensitive and specific for detecting H. pylori and can provide reassurance regarding your infection status.

Regarding your concern about the recurrence of ulcers, it is indeed true that treating H. pylori can lower the recurrence rate significantly. If you were to have an undetected H. pylori infection, it could lead to a higher likelihood of ulcer recurrence even after treatment with PPIs. Therefore, confirming the absence of H. pylori is a prudent step before concluding your treatment plan.

As for the medications you mentioned—Alginic acid (such as Algitab) and Cimetidine—these can potentially affect the accuracy of the C13 breath test. Alginic acid is generally considered safe and does not interfere with the test. However, Cimetidine, being an H2 receptor antagonist, can reduce gastric acid secretion and may alter the dynamics of H. pylori detection. It is advisable to stop taking Cimetidine at least 24 hours before undergoing the C13 breath test to ensure accurate results.

In summary, your understanding of the relationship between duodenal ulcers and H. pylori is correct, and your proactive approach to confirm your H. pylori status is commendable. It is essential to communicate with your healthcare provider about your concerns and the steps you wish to take regarding further testing and treatment. If H. pylori is confirmed, a tailored treatment plan involving PPIs and antibiotics will be necessary to effectively manage your condition and reduce the risk of recurrence. Additionally, maintaining a healthy lifestyle, managing stress, and avoiding irritants such as NSAIDs, alcohol, and smoking can further support your gastrointestinal health.

Similar Q&A

Understanding Duodenal Ulcers and H. Pylori: Seeking a Second Opinion

Hello: A couple of weeks ago, I had an upper gastrointestinal endoscopy, and the doctor told me that I have a duodenal ulcer. He prescribed two types of antibiotics, along with a medication for Helicobacter pylori and an antiemetic. On that day, the doctor did not show me the ima...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
Hello: Duodenal ulcer combined with Helicobacter pylori infection is clinically treated with a triple therapy (two antibiotics + ulcer medication), primarily aiming to eradicate Helicobacter pylori to reduce the risk of ulcer recurrence. If you wish to seek treatment at another h...

Alternative Treatments for Helicobacter Pylori and Ulcers: Beyond Antibiotics

Hello Doctor: I recently had an endoscopy, and the doctor said I have Helicobacter pylori and gastric ulcers as well as duodenal ulcers. I took antibiotics for a day but felt very uncomfortable, so the doctor decided to stop the medication. I would like to ask if there are any ot...

Dr. Hu Guozheng reply Gastroenterology and Hepatology
If the physician assesses that medication should be discontinued, they will likely provide recommendations for subsequent treatment. Please consult your primary physician for further advice, and for issues related to malnutrition, you may consult a nutritionist. Thank you.

Chronic Duodenal Ulcers and Persistent H. Pylori: Treatment Options

Dr. Chen: Hello, I have been suffering from a duodenal ulcer for two years. Last year, during an endoscopy, Helicobacter pylori was detected. I followed the doctor's advice and took medication for two weeks to treat the H. pylori infection. After completing the treatment, I ...

Dr. Chen Zhiping reply Gastroenterology and Hepatology
Hello, the antibiotic resistance of Helicobacter pylori is a troublesome issue. If the bacteria are still present after a second-line standard treatment (triple therapy for at least one week, confirmed by biopsy or breath tests), a quadruple therapy (adding another antibiotic or ...

Understanding Duodenal Ulcers: Symptoms, Treatment, and Recovery Time

Hello Doctor: Recently, I underwent an upper gastrointestinal endoscopy and tested for Helicobacter pylori, which revealed symptoms of duodenal ulcer and gastritis (the Helicobacter pylori test was negative). However, I have been taking medication for nearly two months without an...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: If medications are taken on time, it is important to pay attention to diet and lifestyle habits. Changhua Hospital cares about your health. Dr. Tsai An-shun.