Fast Five Quiz: Review Key Aspects of Peptic Ulcer Disease

Jamie Shalkow, MD


May 11, 2017

The 2017 American College of Gastroenterology (ACG) guideline for the treatment of H pylori infection includes the following recommendations for testing:

  • All patients with active or history of PUD (unless previous cure of H pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue lymphoma, or a history of endoscopic resection of early gastric cancer

  • Patients with dyspepsia who are undergoing upper endoscopy (gastric biopsy specimens)

  • Patients on long-term, low-dose aspirin

  • Patients initiating long-term therapy with NSAIDs

  • Patients with unexplained iron deficiency anemia following standard workup

  • Adults with idiopathic thrombocytopenic purpura

Obtain histopathology, often considered the criterion standard to establish a diagnosis of H pylori infection, if the rapid urease test result is negative and a high suspicion for H pylori persists (presence of a duodenal ulcer).

Antibodies (immunoglobulin G) to H pylori can be measured in serum, plasma, or whole blood. Results with whole blood tests obtained from finger sticks are less reliable.

Fecal antigen testing identifies active H pylori infection by detecting the presence of H pylori antigens in stools. This test is more accurate than antibody testing and is less expensive than urea breath tests.

For more on the workup of PUD, read here.


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