Should You Take Antibiotics for Helicobacter Pylori in Gastritis?

Should I take medication to eradicate Helicobacter pylori?

I underwent an upper gastrointestinal endoscopy in mid-October and was diagnosed with hemorrhagic gastritis (without ulcers).
The doctor changed my medications several times, but there was still no significant improvement.
After about 1.5 months, it resolved on its own.
Around December 20, I started feeling uncomfortable again, with excessive stomach acid and bloating.
On January 6, I had another endoscopy, which indicated that I had quite severe gastritis (without bleeding or ulcers), and I tested positive for Helicobacter pylori (why is there no index?).
The doctor then prescribed a regimen for eradicating Helicobacter pylori (Amoxicillin 250mg x 4 + Clarithromycin 500mg x 1 + Esomeprazole 40mg x 1) to be taken twice a day for 7 days, and we would reassess afterward.
I feel very nauseous after taking the medication.
My questions are: Is it necessary to take the Helicobacter pylori eradication medication for gastritis? Although I have been feeling unwell recently, taking regular antacids has not improved my condition.
Also, how does the doctor know that my gastritis is definitely caused by Helicobacter pylori? Thank you in advance for your prompt reply!

Xiao Qi, 30~39 year old female. Ask Date: 2003/01/07

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! Among all gastric diseases, gastritis is the most prevalent and also one of the most challenging to treat.
This is due to the numerous causes it can have, including diet, medications, emotional stress, and infections.
Although there is a close relationship between Helicobacter pylori and gastritis (approximately 80% of gastritis patients have this bacterium), the symptoms it causes are not directly correlated.
In other words, even if the bacterium is eradicated, it does not necessarily improve the symptoms.
Therefore, in cases of persistent gastritis, consideration may be given to medication to eradicate this bacterium; however, the fundamental solution lies in dietary and emotional management.
Medication serves only to treat the symptoms, while endoscopy is focused on ruling out the possibility of ulcers or cancer.
(P.S.
Currently, the rapid test for Helicobacter pylori is qualitative, with results categorized as (+) to (+++) indicating the bacterial load from high to low).
Best wishes for health from Dr.
Yang Pei-Chen, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/01/07

More Info

When it comes to the treatment of gastritis, particularly when Helicobacter pylori (H. pylori) is involved, the decision to use antibiotics is often based on a combination of clinical guidelines, the severity of symptoms, and the presence of the bacteria itself. In your case, the presence of H. pylori, as indicated by your recent endoscopy, suggests that this bacterium could be contributing to your gastritis symptoms.

H. pylori is a common bacterium that infects the stomach lining and is known to be associated with various gastrointestinal conditions, including gastritis and peptic ulcers. It is estimated that about 50% of the world's population is infected with H. pylori, but not everyone will experience symptoms or complications. The bacteria can lead to chronic inflammation of the stomach lining, which is what gastritis essentially is.

In your situation, the doctor has recommended a treatment regimen that includes antibiotics (Amoxicillin and Clarithromycin) along with a proton pump inhibitor (Esomeprazole). This combination is often referred to as triple therapy and is the standard approach for eradicating H. pylori. The antibiotics work to kill the bacteria, while the proton pump inhibitor reduces stomach acid, allowing the stomach lining to heal.

You raised a valid question about whether it is necessary to take antibiotics for H. pylori in the context of gastritis. The answer is that while not all cases of gastritis require antibiotic treatment, if H. pylori is present and symptomatic, eradication is generally recommended. This is especially true if you have had recurrent symptoms, as untreated H. pylori can lead to chronic gastritis and increase the risk of developing more serious conditions, such as peptic ulcers or even gastric cancer over time.

Regarding your concern about the nausea you experienced while taking the prescribed medications, it is not uncommon for some patients to experience gastrointestinal side effects from antibiotics. If the nausea is severe or persistent, it is important to communicate this with your healthcare provider, as they may need to adjust your treatment plan or provide supportive care to manage these side effects.

As for the question of how your doctor determined that your gastritis is likely related to H. pylori, this is typically based on a combination of your symptoms, the results of your endoscopy, and the presence of the bacteria. In many cases, doctors will perform a biopsy during an endoscopy to test for H. pylori, or they may use non-invasive tests such as breath tests or stool antigen tests. The positive result for H. pylori indicates that the bacteria are present, which can be a significant contributing factor to your gastritis.

In summary, while not every case of gastritis necessitates antibiotic treatment for H. pylori, your situation, characterized by positive H. pylori results and ongoing symptoms, suggests that treatment is warranted. It is essential to follow your doctor's recommendations and complete the prescribed course of antibiotics to effectively address the infection and alleviate your symptoms. If you have concerns about the treatment or experience side effects, do not hesitate to reach out to your healthcare provider for further guidance.

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