PUD is most frequently caused by Helicobacter pylori infection or by use of NSAID
Inexpensive, reliable diagnostic tests for H. pylori infection have been
developed; definitive testing for H. pylori infection can now be performed
by primary care physicians without referral to a gastroenterologist. The infection
can be cured with a combination regimen that includes selected antibiotics and proton
What are the symptoms of PUD?7
Abdominal discomfort is the most common symptom. This discomfort usually:
- Is a dull, gnawing ache
- Comes and goes for several days or weeks
- Occurs 2 to 3 hours after a meal
- Occurs in the middle of the night – when the stomach is empty
- Is relieved by eating
- Is relieved by antacid medications
Other symptoms include:
- Weight loss
- Poor appetite
Differential Diagnosis of H. pylori infection
In uninvestigated patients, consideration of H. pylori-related PUD is necessary
- Likelihood of biliary tract disease, pancreatitis, and cancer is judged to be low,
based on history and the age of the patient (cancer is rare in patients under the
age of 50).
- There are no alarm symptoms, including dysphagia, GI bleeding, new-onset symptoms
after the age of 55 years, unexplained anemia or weight loss, and severe vomiting
suggestive of upper GI carcinoma.
- Use of NSAIDs has been stopped or ruled out.
- The patient does not have classic heartburn suggesting GERD.
- The patient apparently has a history suggestive of ulcer disease on history-taking
and physical examination.
H. pylori status should be established in symptomatic patients younger than
55 years of age who are otherwise healthy and have no warning signs or symptoms
suggesting the need for endoscopy.
If the test result is positive, an anti-H. pylori treatment regimen should
be initiated; if the test result is negative and symptoms persist, further evaluation
may be required. Note that a positive result on diagnostic testing (i.e. HpSA®)
is a prerequisite to treatment for H. pylori infection. Without confirmation
of H. pylori activity, antibiotics should not be given.
H. pylori and GERD
It should be noted that some patients have more than one disease concurrently (i.e.,
PUD and GERD). Empiric treatment for GERD with an H2-receptor antagonist or proton
pump inhibitor is acceptable.
about current testing options for H. pylori infection