## Diagnosis and Clinical Context The clinical and histopathological findings confirm **Helicobacter pylori infection**: - Chronic epigastric symptoms (pain, early satiety) - Endoscopic findings: chronic active gastritis with intestinal metaplasia - **Rapid urease test positive** — gold-standard rapid diagnostic test for H. pylori **Key Point:** H. pylori is the leading cause of peptic ulcer disease and chronic gastritis worldwide. Intestinal metaplasia indicates advanced mucosal damage and increased gastric cancer risk, making eradication therapy urgent. **High-Yield:** Positive rapid urease test is >95% sensitive and specific for active H. pylori infection and mandates immediate eradication therapy. ## Standard Eradication Therapy: Triple Therapy ### First-Line Regimen (India & WHO) | Component | Dose | Frequency | Duration | |---|---|---|---| | **Proton pump inhibitor (PPI)** | Omeprazole 20 mg | Twice daily | 7 days | | **Amoxicillin** | 1 g | Twice daily | 7 days | | **Macrolide** | Clarithromycin 500 mg | Twice daily | 7 days | **Mnemonic:** **OAC** = Omeprazole + Amoxicillin + Clarithromycin (the classic triple therapy) ### Mechanism of Action - **PPI:** Suppresses gastric acid, creating an alkaline microenvironment where antibiotics are more effective - **Amoxicillin:** β-lactam antibiotic; bactericidal against H. pylori - **Clarithromycin:** Macrolide antibiotic; inhibits protein synthesis ### Expected Outcomes - **Eradication rate:** 85–90% with compliant patients - **Symptom resolution:** 70–80% within 2–4 weeks post-therapy - **Healing of gastritis:** 6–12 weeks **Clinical Pearl:** Intestinal metaplasia is a pre-malignant lesion (OLGA/OLGIM staging). H. pylori eradication halts progression and may partially reverse early metaplasia, reducing gastric cancer risk by ~30–40% if done before extensive atrophy develops. ## Why Other Options Are Incorrect
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