h.pylori - pursuitof99

[ArchivalUser]

You are right about "test and treat" strategy; only ulcer dyspepsia goes for that, non-ulcer dyspepsia like GERD doesn't follow the rule and as to functional dyspepsia-only some subsets of patients, depending on the prevalence of H. pylori in the community: if it is low, it is recommended to go for a PPI trial; if it is high, then "test-and-treat" strategy (PPI trial is more cost-effective than an initial test-and-treat strategy for these patients).

The Guideline from American College of Gastroenterology:
http://www.gi.org/physicians/clinicalupd...guidelines

[ArchivalUser]

agree with fcbarcelona ....Never give empirical trial of H2 or PPI ...regardless of age ....think of concept ....most ppl are infected with H.pylori....but only some develop sx....(thats why we don't screen)....but if pt. comes to you with PUD Sx .....you must make sure that whether he/she has H pylori causative ulcer.....?? if yes then -PPI + TRiple regimen....

initial Dx by Urea breath test as well as check the same for f'up ...if UBT negative (you can associate with stool ag test )...then go for serology & make sure you are not missing H pylori ...if -ve & severe Sx .... then endo + Bx ......( point is where to end for Dx)
only exception to go directly for scopy is when older age + alarming sx .....

Empirical PPI only for -ve serology .....& mild Sx


If after doing all that you still don't find th cause & despite empirical PPI pt have recurrence....this is IDIOPATHIC ulcer (10-20 %) ppl have this ....

H pylori is type 1 carcinogen ---you can't affford to treat with just empirical Rx.....

[ArchivalUser]

thank u guys for all ur inputs.......it clears my concept now.......

[ArchivalUser]

thanks odin for the link.

wt u said is right 100%, it depends upon the H.P prevalence in society.
but the problem when u face such a question in the exam u can't determine the pre test probability

Anyway, i think they will NOT ask us to choose between these 2 choices that simply.
they must give us a clue.

Tnx odin again.

All the best.

[ArchivalUser]

thnx odin

[ArchivalUser]

You are welcome. Take a look at the H pylori guideline and at the Dyspepsia one. These 2 should cover our questions, I guess.

[ArchivalUser]

yup....but you know for usmle purpose i think thats too much.....MIMP thing wht I found was cut off 55 yrs age .....