Deciding which treatment is best for patients with symptoms of dyspepsia or peptic ulcer disease depends on a number of factors.
An endoscopy to identify any ulcers and test for H. pylori probably gives the best guidance for treatment. However, dyspepsia is such a common reason for a doctor's visit that many people are treated initially based on their symptoms and blood or breath H. pylori test results. This approach (called test and treat) is considered an appropriate option for most patients. Patients who have evidence of bleeding or other alarm symptoms, or who are over age 50 should have an endoscopy performed first.
Approach to Patients Who Are Not Taking NSAIDs
If an endoscopy is performed soon after the patient first visits a doctor for symptoms, treatment is based on the results of the endoscopy:
- If an ulcer is seen and the patient is infected with H. pylori, treatment for the infection is started, followed by 4 - 8 weeks of treatment with a proton pump inhibitor (PPI). Most patients will improve with this treatment.
- If an ulcer is seen but H. pylori are not present, patients are usually treated with PPIs for 8 weeks.
- If no ulcer is seen and the patient is not infected with H. pylori, the first treatment attempt will usually be with PPIs. These patients do not need antibiotics to treat H. pylori. Other possible causes of their symptoms should also be considered.
Most patients who do not have risk factors for complications are treated without first having an endoscopy. The type of treatment is decided based on a patient's symptoms, and on the results of H. pylori blood or breath tests.
Review Date: 07/18/2011
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.