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Helicobacter pylori — ABIM Board MCQ

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ModerateGastroenterologyHelicobacter pyloriABIM Board

A 33-year-old man presents with dyspepsia and has a positive urea breath test for Helicobacter pylori. He has never received H. pylori eradication therapy, has no drug allergies, and no antimicrobial susceptibility results are available. Which of the following is the preferred empiric eradication regimen?

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Correct answer: D — Proton pump inhibitor, bismuth, tetracycline, and metronidazole for 14 days

The correct answer is D. For treatment-naive H. pylori infection when antimicrobial susceptibility is unknown, the 2024 ACG guideline prefers 14 days of optimized bismuth quadruple therapy: a proton pump inhibitor, bismuth, tetracycline, and metronidazole. Clarithromycin triple therapy should not be selected empirically because clarithromycin resistance substantially reduces eradication efficacy; it is appropriate only when susceptibility is demonstrated. Levofloxacin-containing therapy similarly should not be used empirically without documented susceptibility. Sequential clarithromycin-based therapy is not the preferred contemporary US first-line regimen. Substituting doxycycline for tetracycline does not constitute the guideline-specified optimized bismuth regimen and may have less reliable eradication efficacy.

Reference: Chey WD, Howden CW, Moss SF, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. American Journal of Gastroenterology. 2024;119(9):1730-1753. https://pubmed.ncbi.nlm.nih.gov/39626064/