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H. Pylori Testing & Uninvestigated Dyspepsia

H. Pylori Testing & Uninvestigated Dyspepsia

Gastritis, dyspepsia, and peptic ulcer disease are common causes of abdominal pain that may be caused by Helicobacter pylori infection. When people with peptic ulcers have H. pylori infections, antibiotic treatment can help speed the initial healing of some ulcers and may prevent ulcers from returning. Testing for H. pylori infection is uncommon in EDs in the United States despite abdominal pain being one of the most common complaints in ED visits. Test & Treat In general, a “test and treat” strategy is recommended for patients with uninvestigated dyspepsia who do not have “red flags” for cancer. Successful identification of infection in the ED and initiation of antibiotic treatment may reduce future risk of gastritis, gastric lymphoma, and gastric cancer. This approach may also be cost-effective by reducing future healthcare costs and symptom severity. Why Test? In my opinion, there are a few reasons why testing and treating for H. pylori infection should not be performed in ED patients who have uninvestigated dyspepsia and do not have red flags for more serious disease. First, testing can occur at the bedside with almost real-time results. Second, a positive test leads to an immediate change in how patients are managed. Third, treatment of H. pylori infection may have beneficial downstream effects on healthcare utilization. These include decreases in: • Long-term proton pump inhibitor use. • Inappropriate use of endoscopy. • Future doctor visits. In our ED at George Washington University, the prevalence of H. pylori infection is roughly 25% in symptomatic patients. Using a test and treat approach, we have anecdotally observed a high degree of physician and patient satisfaction. How...
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