USMLE Forums banner
1 - 11 of 11 Posts

·
Registered
Joined
·
675 Posts
Discussion Starter · #1 ·
Patient presents with symptoms typical of peptic ulcer disease (whether duudonal or gastric).
What's the best next step?
Endoscopy, H. Pylori testing, or start directly with triple therapy?
 

·
Registered
Joined
·
1,216 Posts
Depends on the age of the patient. You gotta use these 3 rules

1. For example if you have a 55 year old presenting with new onset peptic ulcer disease you have to start with an endoscopy.. Why? because the odds of gastric cancer are just to high to play with them.​

2. Look for "warning symptoms" these are¨: New onset dysphagia, Anemia, Guiac positive, Weight loss, Night sweats. If the patient has this then you start with endoscopy regardless of age.

3. If the patient is young, less than 45 years old and overall seems fine then you go directly with H.pylori testing.

It also depends on what the question is asking and the options provided, most of the time you just dont go and treat H.pylori because the most common cause of PUD-like symptoms is NON ulcer dyspepsia, you cant assume the patient has an ulcer or an active H.pylori infection without endoscopy and h.pylori tests.

You dont treat every patient with a serology positive for H.pylori because 1/3rd of the worlds population is colonized by H.pylori and you dont want to increase resistance or risk it for that matter.
 

·
Registered
Joined
·
1,406 Posts
Depends on the age of the patient. You gotta use these 3 rules

1. For example if you have a 55 year old presenting with new onset peptic ulcer disease you have to start with an endoscopy.. Why? because the odds of gastric cancer are just to high to play with them.​

2. Look for "warning symptoms" these are¨: New onset dysphagia, Anemia, Guiac positive, Weight loss, Night sweats. If the patient has this then you start with endoscopy regardless of age.

3. If the patient is young, less than 45 years old and overall seems fine then you go directly with H.pylori testing.

It also depends on what the question is asking and the options provided, most of the time you just dont go and treat H.pylori because the most common cause of PUD-like symptoms is NON ulcer dyspepsia, you cant assume the patient has an ulcer or an active H.pylori infection without endoscopy and h.pylori tests.

You dont treat every patient with a serology positive for H.pylori because 1/3rd of the worlds population is colonized by H.pylori and you dont want to increase resistance or risk it for that matter.
......this.
 

·
Registered
Joined
·
675 Posts
Discussion Starter · #10 ·
Depends on the age of the patient. You gotta use these 3 rules

1. For example if you have a 55 year old presenting with new onset peptic ulcer disease you have to start with an endoscopy.. Why? because the odds of gastric cancer are just to high to play with them.​

2. Look for "warning symptoms" these are¨: New onset dysphagia, Anemia, Guiac positive, Weight loss, Night sweats. If the patient has this then you start with endoscopy regardless of age.

3. If the patient is young, less than 45 years old and overall seems fine then you go directly with H.pylori testing.

It also depends on what the question is asking and the options provided, most of the time you just dont go and treat H.pylori because the most common cause of PUD-like symptoms is NON ulcer dyspepsia, you cant assume the patient has an ulcer or an active H.pylori infection without endoscopy and h.pylori tests.

You dont treat every patient with a serology positive for H.pylori because 1/3rd of the worlds population is colonized by H.pylori and you dont want to increase resistance or risk it for that matter.
Correct me if I'm wrong, for best initial step:

Heart burn (clinical suspicion of GERD):
-young and no "alarm signs"---> empiric PPI's
-old and/or "alarm signs"---> endoscopy

Epigastric pain (clinical suspicion of gastritis, PUD, NUD):
-young and no "alarm signs"---> H. Pylori testing. If positive then triple therapy, if negative then PPI's
-old and/or "alarm signs"---> endoscopy
 

·
Registered
Joined
·
1,216 Posts
Correct me if I'm wrong, for best initial step:

Heart burn (clinical suspicion of GERD):
-young and no "alarm signs"---> empiric PPI's
-old and/or "alarm signs"---> endoscopy

Epigastric pain (clinical suspicion of gastritis, PUD, NUD):
-young and no "alarm signs"---> H. Pylori testing. If positive then triple therapy, if negative then PPI's
-old and/or "alarm signs"---> endoscopy
You are correct
 
1 - 11 of 11 Posts
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Top