Managing acid peptic disease in the Helicobacter pylori era

The advent of new diagnostic and therapeutic modalities for Helicobacter pylori allows any physician to offer curative antibiotic regimens to patients with peptic ulcer disease and gastritis. This article describes new management strategies and discusses the advantages of each. In the old strategy, endoscopy was performed on patients with dyspepsia, in the hope of detecting a treatable peptic ulcer. In the new strategy, patients with dyspepsia are investigated with serology to detect those with H. pylori and potentially curable peptic ulcers. Patients with persistent symptoms require a urea breath test and only those who are now H. pylori-negative undergo endoscopy. The cost-effectiveness of these strategies will depend on the expense of each diagnostic test, particularly endoscopy. Whether a noninvasive strategy can be implemented safely may depend also on the incidence of gastric carcinoma in a particular population and the effectiveness of antibacterial therapy at reducing cancer risk.