A 45-year-old H. pylori-positive patient presents with a bleeding duodenal ulcer (Forrest Ia — spurting arterial hemorrhage) at endoscopy. After achieving hemostasis, what is the current evidence-based management of H. pylori?

• A Confirm eradication only after 8 weeks of PPI therapy
• B Begin H. pylori eradication therapy within the same hospital admission; test for eradication 4 weeks after completing antibiotics while off PPI for 2 weeks ✓
• C H. pylori treatment should be deferred until after 6 months to allow ulcer healing
• D Triple therapy is unnecessary if patient achieves endoscopic hemostasis

Explanation

H. pylori eradication should be initiated as soon as oral intake is possible after endoscopic hemostasis for bleeding peptic ulcer. European (ESGE) and Maastricht VI consensus guidelines recommend confirming eradication 4–8 weeks after completing antibiotics — urea breath test or stool antigen test should be performed at least 4 weeks after completing antibiotics and 2 weeks after stopping PPI to avoid false negatives. Eradication substantially reduces rebleeding risk (from ~30% to <5% at 1 year) and the need for long-term acid suppression in the absence of NSAID use.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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