Is it necessary to do the H. Pylori test?

[cliffh65]

In a <45YO, generally healthy patients who has the Dyspepsia symptoms, what should we do next?
Do the H. Pylori test and treat it? Or Empiric trial of H2 blockers liquid antacids, or PPIs?

I am confused between the conclusions from UW and Kaplan:
UW:
In 1998, the American Gastroenterological Association recommended that patients with dyspepsia, age younger than 45 years, and presentation without any alarming symptoms (e.g., bleeding, anemia, dysphagia, and weight loss) should have a noninvasive test for H. pylori (i.e., serologic or breath test).

Kaplan-IM-p6
Although endoscopy is the most accurate means of diagnosing an ulcer, one can empirically treat ulcers, reflux disease, and gastritis.
Patients who do not have duodenal or gastric ulcers or gastritis should not be treated for H. pylori .
Young, generally healthy patients can be treated empirically with H2 blockers, liquid antacids, or PPIs, and then undergo endoscopy in the future if there is no improvement.
Remember that there is no point in treating a He/icobacter. pylon infection without evidence of disease such as gastritis or ulcer disease.

Please help me. Thanks!!!

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[slazenger]

IMO In practice, H Pylori stool antigen (not culture) should be performed to dx active disease and then used following treatment to confirm eradication.

 

[46&2]

The official guidelines are a little complex:
http://www.gastrojournal.org/article/PIIS0016508505018172/fulltext

If you're <55 yr old (no alarm symptoms) with...

1) typical GERD symptoms (heartburn), empiric therapy at first
2) heavy NSAID usage, d/c them for awhile
3) dyspepsia WITHOUT 1 or 2, then test for H. pylori

...so it seems the patient you mentioned should get a trial of empiric therapy.

 

[RastaMan]

Dyspepsia with no alarm symptoms:
1st step on exam - test and treat for H. Pylori (i think screening test recommended is H. Pylori).
In practice, i think there's some controversy because patient satisfaction is much higher with initial endoscopy, so the major societies said this was one option.

2nd step on exam if no relief with H. Pylori treatment - empiric therapy with PPI or H2 blocker (i think for about 8 weeks)

3rd step on exam with no relief with antisecretory meds - upper endoscopy

Dyspepsia with any alarm symptoms - 1st step is endoscopy

 

[RastaMan]

In that first line, i meant screening test recommended was serology for H. Pylori, as far as i know.

 

[RastaMan]

Oh yeah, and if the symptoms are dyspepsia along with hearburn and regurgitation, the most likely diagnosis is GERD and not PUD, so initial therapy is H2 blocker or PPI (i think thats what kaplan was trying to say)

 

[RastaMan]

Sorry...initial test for H. Pylori is stool antigen or urea test as another poster mentioned.

 

[cliffh65]

Thanks slazenger, 46&2 and RastaMan.
46&2, the web information is so useful!
To my understanding, there are many Management Options for the New-Onset Dyspepsia. But it is preferred to have a H pylori test done, although (1) empirical H2-receptor antagonist therapy and (2) empirical proton pump inhibitor (PPI) therapy are also optional.
Summary:
The conclusion from Kaplan is not accurate?
For the real exam, if both H pylori test and empirical treatment (without H pylori test) are the choices as the “what is the next management?” We choose H pylori test?

 

[RastaMan]

If the patient < 45 years has dyspepsia, no alarm symptoms, and no NSIAD use then yes the answer is to test for H. Pylori first.

If the patient has dyspepsia + heartburn or regurgitation, then the answer is empiric H2 blocker or PPI