Peptic ulcer esophagogastroduodenoscopy
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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Guidlines for factors that predict the successful eradication when treating H. pylori infection |
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Guidelines to document H. pylori antimicrobial resistance in the North America |
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Guidelines for evaluation and testing of H. pylori antibiotic resistance |
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Guidelines for when to test for treatment success after H. pylori eradication therapy |
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Guidelines for penicillin allergy in patients with H. pylori infection |
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Peptic ulcer esophagogastroduodenoscopy On the Web |
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American Roentgen Ray Society Images of Peptic ulcer esophagogastroduodenoscopy |
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Risk calculators and risk factors for Peptic ulcer esophagogastroduodenoscopy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Peptic ulcer esophagogastroduodenoscopy
According to American College of Gastroenterology (ACG) guidelines 2017 for the treatment of H pylori infection (HPI) include the following recommendations for testing for H pylori:[1]
- Active or past history of peptic ulcer disease.
- Low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma
- Confirmed history of PUD (not previously treated for H. pylori)
- Long-term therapy with nonsteroidal anti-inflammatory agents (NSAIDs) and low-dose aspirin
- Unexplained iron deficiency anemia following standard workup
- Idiopathic thrombocytopenic purpura
Pre-endoscopic medical therapy
- Intravenous infusion of erythromycin 250 mg,30 min before endoscopy) can be given to improve diagnostic yield and decrease the need for repeat endoscopy
- Intravenous PPI 80 mg bolus followed by 8 mg/h infusion can be given to decrease the number of patients who have higher risk of bleeding at endoscopy[2]
Timing of endoscopy
- Patients with bleeding ulcer should undergo endoscopy within 24 h of admission, following resuscitative efforts to stabilize hemodynamically
- Hemodynamically stable patients ,endoscopy should be performed early and discharged on the same day
- Patients with unstable signs and symptoms e.g., tachycardia, hypotension, bloody emesis or nasogastric aspirate in the hospital endoscopy should be done within 12 hours
Different endoscopic testing methods
- Endoscopy with biopsy is recommended to diagnose cancer and other causes in patients 55 years or older, or with one or more alarm symptoms such asunexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia, or jaundice[3]
- Patients who have not been taking a PPI within one to two weeks of endoscopy, or bismuth or an antibiotic within four weeks, the rapid urease test performed on the biopsy specimen provides an accurate, inexpensive means of diagnosing H. pylori infection.
- Patients who have been on these medications will require histology, with or without rapid urease testing. Culture and polymerase chain reaction allows for susceptibility testing[4][5]
Algorithm for the Approach to Dyspepsia
| Age ≥ 55 or ⊕ alarm features*? | |||||||||||||||||||||||||||||||||||||
| YES | NO | ||||||||||||||||||||||||||||||||||||
| Endoscopy | H. pylori prevalence? | ||||||||||||||||||||||||||||||||||||
| High | Low | ||||||||||||||||||||||||||||||||||||
| Test-and-treat strategy ± acid suppression | Acid suppression trial | ||||||||||||||||||||||||||||||||||||
| If eradication therapy is indicated | |||||||||||||||||||||||||||||||||||||
| Clarithromycin resistance ≥ 20% | Clarithromycin resistance < 20% | ||||||||||||||||||||||||||||||||||||
| Quadruple or sequential therapy | PCA or PCM or Bismuth quadruple therapy | ||||||||||||||||||||||||||||||||||||
| PLA | Bismuth quadruple therapy or PLA | ||||||||||||||||||||||||||||||||||||
| Adjust Rx per susceptibility test | |||||||||||||||||||||||||||||||||||||
| Consider endoscopy if treatment fails | |||||||||||||||||||||||||||||||||||||
- Alarm symptoms-unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia, or jaundice[3]
References
- ↑ {{cite web |url=https://www.nature.com/ajg/journal/v112/n2/pdf/ajg2016563a.pdf |title=www.nature.com |format= |work= |accessdat
- ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
- ↑ 3.0 3.1 Bowrey DJ, Griffin SM, Wayman J, Karat D, Hayes N, Raimes SA (2006). "Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked". Surg Endosc. 20 (11): 1725–8. doi:10.1007/s00464-005-0679-3. PMID 17024539.
- ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
- ↑ Girdalidze AM, Elisabedashvili GV, Sharvadze LG, Dzhorbenadze TA (2013). "[Comparative diagnostic value of Helicobacter pylori infection testing methods]". Georgian Med News (in Russian) (225): 53–60. PMID 24423677.