How is H pylori eradicated?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

The use of the prokinetics agent to empty the stomach of retained blood or clots to improve endoscopic visualization has been extensively studied. To date, four large randomized controlled trials and three meta-analyses have shown that erythromycin reduces the need for second-look endoscopy but did not significantly reduce clinical outcomes such as blood transfusions, hospital stay, or surgery. [81, 159, 160, 161, 162, 163, 164]

In a meta-analysis by Barkun et al, there were no significant benefits to pre-esophagogastroduodenoscopy metoclopramide therapy, but the findings were limited by the small sample of patients (n = 28), which was represented in abstract form only. [81] Darum and Garretson reported on their experience in a single institution utilizing metoclopramide as a prokinetic in UGIB and found that metoclopramide did not improve visualization during endoscopy when compared with placebo. [166]

The potential side effects of metoclopramide, such as extrapyramidal symptoms or tardive dyskinesia are primarily associated with chronic use; however, due to an FDA black box warning on metoclopramide, the risks have to be balanced against the potential benefit in this setting. [167]


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