Dyspepsia and Helicobacter Pylori in Refugee Patients

Overview

H. pylori infection is very common in patients from developing nations and is frequently found when investigating refugee patients with dyspepsia (postprandial fullness, early satiety, epigastric pain or burning).

Different cultures may describe dyspeptic symptoms as 'heat' or 'noise' in the abdomen.

Also consider parasites as a cause: hookworms, strongyloides, giardia, and Dientamoeba fragilis can mimic dyspepsia. Order stool tests alongside H. pylori testing.

Alarm Features Requiring Endoscopy

Refer for endoscopy if any of the following are present:

*     Onset at age 60 or older

*     Weight loss

*     Anemia or iron deficiency

*     Dysphagia

*     Persistent vomiting

*     Palpable abdominal mass or lymphadenopathy

*     Family history of upper GI cancer

H. pylori Testing

First-line test in Calgary: Stool antigen test.

Before collecting the sample, patients must stop:

*     Proton pump inhibitors: 14 days

*     Antibiotics: 28 days

*     Bismuth preparations (Peptol Bismol): 14 days

When ordering the stool H. pylori test, also order Stool Ova and Parasites and Protozoal Screen (complete the CLS Stool and Parasite History Form).

Treatment - CLAMET Quadruple Regimen (preferred)

Prescribe in blister packs (note this on the prescription) to improve adherence.

Test-of-Cure

Only perform if the patient is still symptomatic after treatment. Repeat stool antigen test more than 4 weeks after completing treatment. If still positive, escalate to Bismuth Quadruple Regimen (second line) or Levofloxacin-based Regimen (third line).