Gastroenterology · USMLE Step 1 and Step 2

H. pylori Triple Therapy song

H. pylori - Triple Therapy & Eradication, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

H. pylori Triple Therapy

Full song on YouTube ↗Spotify ↗

Key points in this song10

H. pylori triple therapy consists of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin (or metronidazole if penicillin-allergic) given for 14 days.
H. pylori is a gram-negative, urease-positive rod that colonizes the gastric antrum and is the most common cause of peptic ulcer disease worldwide.
Urease produced by H. pylori converts urea to ammonia and CO₂, raising local pH and enabling survival in the acidic stomach — the basis for the urea breath test.
First-line diagnostic tests include urea breath test and fecal antigen test; both require stopping PPIs for 2 weeks and antibiotics for 4 weeks before testing to avoid false negatives.
Endoscopic biopsy with urease (CLO) test or histology is preferred when endoscopy is already indicated (e.g., alarm symptoms such as weight loss, dysphagia, or GI bleeding).
H. pylori infection is strongly associated with gastric MALT lymphoma; eradication of H. pylori alone can lead to remission of low-grade MALT lymphoma.
H. pylori is the single greatest risk factor for gastric adenocarcinoma, classified as a Group 1 carcinogen by the WHO.
Test-of-cure is required after completing treatment; urea breath test or fecal antigen test (not serology) should be performed at least 4 weeks after completing therapy.
Serology (IgG antibody) can confirm prior exposure but cannot distinguish active from past infection and should not be used to confirm eradication.
H. pylori–associated duodenal ulcers result from increased gastric acid secretion due to decreased somatostatin from antral D cells, leading to uninhibited gastrin release and excess acid production.