UMMC Guidelines Oversight Team

Objectives: (1) Implement a cost effective strategy incorporating testing for and eradication of Helicobacter pylori (HP) in patients with suspected peptic ulcer disease (PUD). (2) Reduce ulcer recurrence and prevent the overuse of chronic anti-secretory medications in PUD patients. Key points ■ Clinical approach. Ulcers are caused by an infection of a bacterium known as Helicobacter pylori or H. pylori. Eradication of HP infection alters the natural history of peptic ulcer disease. Successful eradication reduces PUD recurrence rate from 90 % to < 5 % per year [A*]. PUD generally does not recur in the successfully treated patient unless nonsteroidal anti-inflammatory drug (NSAID) use is present. ■ Diagnosis. Economic analyses demonstrate a cost effectiveness advantage of non-invasive testing and antibiotic therapy for HP in patients with symptoms suggestive of PUD when compared to immediate endoscopy. [evidence: C*] Testing for active HP infection (stool antigen or urea breath testing) is more appropriate than serology testing in areas with low prevalence of active HP infection to reduce unnecessary treatment of individuals without active HP infection. ■ Treatment. H. pylori eradication therapy consists of antibiotics and anti-secretory drugs. [A*