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Experts will explore challenges of recalcitrant H. pylori treatment in annual Peura Lecture

Five experts will discuss optimized treatment strategies for Helicobacter pylori infection during the annual Kristin and David Peura, MD, Lecture, Saturday afternoon. The 90-minute AGA Clinical Symposium is titled Help! I Can’t Get Rid of H. Pylori.

“While it’s true that H. pylori is more prevalent outside the U.S., I have a clinic full of patients sent by other gastroenterologists who can’t get rid of the infection,” said symposium co-moderator John Y. Kao, MD, AGAF, associate professor of medicine at the University of Michigan Health System, Ann Arbor. “Some of these patients have gone through as many as 10 courses of antibiotics without success and they are asking for help.”

The reality is that H. pylori can be treated successfully if every detail is accounted for, said Dr. Kao, noting that many clinicians focus on using the appropriate antibiotics and often miss key factors, such as stomach pH.

“Some physicians talk about treatment failure being the result of patients not taking the antibiotic regimen,” Dr. Kao said. “That may not be the real reason. You can have patients who are perfectly compliant with their antibiotic regimen who fail treatment. You have to remember that stomach pH is also an important factor and patients respond differently to different PPIs [proton pump inhibitors], and their diet may have an impact on stomach acidity.”

The literature shows that most patients who have successful eradication of H. pylori have a stomach pH of 5.5 or higher. That compares to a normal pH of 2.0 to 2.5. Failing to adequately increase stomach pH means oral antibiotics are destroyed in the stomach before they can have an effect on the infection.

A recent study demonstrated the effectiveness of using high-dose PPI in combination with amoxicillin in primary and salvage therapies. In that study, Dr. Kao noted, patients were instructed to avoid foods that may impact stomach pH.

“If you are trying to treat H. pylori and bring the pH level down with medication while your patient is drinking soda pop, eating spicy foods and adding tomato sauce, that’s not going to be helpful,” he explained. “Diet is one of those things we don’t always think about when considering the next course of action for a patient with an infection that is difficult to eradicate.”

Although new antimicrobials that show promise against H. pylori have been approved outside the U.S., Dr. Kao said there are no new agents being considered for approval here, leaving clinicians dependent on familiar treatments.

“This will be a very practical session with expert advice on how to optimize your chance of getting rid of your patient’s H. pylori.” Dr. Kao said. “The reality is that clinicians use a trial-and-error approach after the patient fails the standard first- and second-line therapies. That’s why it is so important to understand the factors that really cause people to fail therapy.”

Please refer to the DDW Mobile App or the Program section in Saturday’s DDW Daily News for additional details on this and other DDW® events.

Donor Corner

David A. Peura, MD, AGAF, and Kristin Peura

Why is the research symposium important?
Dr. Peura: It is through research symposia such as this that the latest, cutting-edge information and technology can be shared in a forum that engenders dialogue between respected clinical investigators and practicing clinicians, with patients being the ultimate beneficiaries.

What does it mean for you to support the AGA Research Foundation through a research symposium?
Dr. Peura: As a practicing academic clinical gastroenterologist, I have personally benefited from attending and participating in research symposia over the four decades that I have been an AGA member. It was an easy decision for my wife Kristin and I to provide philanthropic support to ensure this forum remains viable and vital for future generations of practicing digestive disease specialists.

AGA is grateful to its donors for their generous contributions, which go directly to the AGA Research Foundation awards program endowment to support future research in the field.

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