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With this approach, patients undergo a noninvasive test for infection and, if positive, are treated with eradication therapy.
This strategy reduces the need for antisecretory medications as well as the number of endoscopies.
Continuing antisecretory maintenance therapy for more than two weeks following antibiotic treatment is unnecessary after eradication provides a small and highly variable symptomatic benefit in patients with nonulcer dyspepsia. Cost to the patient will be higher, depending on prescription filling fee Estimated cost to the pharmacist based on average wholesale prices (rounded to the nearest dollar) in Red Book. The stool antigen test is an alternative, with the monoclonal antibody-based test being most reliable.
If infected, patients are treated with 14 A long-term follow-up study comparing a test-and-treat strategy versus prompt endoscopy in patients with dyspepsia showed that the former reduced the number of endoscopies performed as well as the number of antisecretory medications administered.15Patients can be tested for the presence of .
Although serology for immunoglobulin G often is chosen in the outpatient setting because of its convenience, it is less accurate than either the stool antigen or urea breath test.
This article briefly describes the evaluation of the patient with dyspepsia in light of our knowledge of the epidemiology of A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
For information about the SORT evidence rating system, see page295 orhttps://org/A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.