This protocol addresses patients with autoimmune metaplastic atrophic gastritis and confirmed active Helicobacter pylori infection, without a true penicillin allergy, in whom a prior course of empiric salvage eradication therapy has not achieved confirmed eradication.
In patients diagnosed with autoimmune gastritis, undetected or untreated H. pylori infection carries implications for cancer risk and may exacerbate nutritional deficiencies. Testing and treatment are recommended in this population.
The prior empiric salvage eradication therapy — which may have included optimized bismuth quadruple therapy, rifabutin triple therapy, or high-dose dual therapy — did not achieve confirmed H. pylori eradication. The required endpoint — a negative test of cure performed at least 4 weeks after completing therapy — was not reached. This protocol defines the approach taken at that point.
When empiric salvage has not achieved eradication, treatment is guided by antibiotic susceptibility testing of the H. pylori strain, with the regimen selected according to the confirmed sensitivity profile. The complete selection criteria and full regimen details are in the protocol.
Eradication of H. pylori infection, confirmed by a negative test of cure — urea breath test, fecal antigen test, or biopsy-based test — performed at least 4 weeks after completion of therapy.
DOI: 10.14309/ajg.0000000000002968