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Diagnosis

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 pump inhibitors.

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
  • Bloating
  • Burping
  • Nausea
  • Vomiting

Differential Diagnosis of H. pylori infection

In uninvestigated patients, consideration of H. pylori-related PUD is necessary when:

  • 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.

Learn more about current testing options for H. pylori infection


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Patented ELISA for the detection of H. pylori antigens in stool specimens Patented ELISA for the detection of H. pylori antigens in stool specimens.
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Rapid one-step immunoassay for the detection of H. pylori antigens in human stool Rapid one-step immunoassay for the detection of H. pylori antigens in human stool.
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