Peptic ulcer esophagogastroduodenoscopy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Peptic ulcer esophagogastroduodenoscopy

American College of Gastroenterology (ACG) guidelines 2017 for the treatment of H pylori infection (HPI) include the following recommendations for testing for H pylori  :

• 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

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