Upper endoscopy for suspected PUD w/o alarm?
For a young patient w/o alarm symptoms and relatively mild abdominal pain, would you still order upper GI endoscopy? I'm thinking it's unnecessary and is a waste of money. We can just see if the patient will respond to empiric tx anyway.
I'm thinking of just doing rectal exam, FOBT, CBC, (electrolytes if w/ vomiting), then H pylori antibody test. Also, AST, ALT, alk phos, bil, amylase, lipase if I would like to screen for liver and pancreatic pathology.
I'll probably order endoscopy and upright CXR + abdominal xray as part of initial testing only if considering perforated PUD.
What do you think?