Recognizing peptic ulcer disease - Keys to clinical and laboratory diagnosis

An algorithmic approach to evaluation of dyspepsia or abdominal discomfort begins with differentiation between peptic ulcer disease and gastroesophage al reflux disease as well as recognition of alarm signs and symptoms for ga stric cancer, which are indications for early endoscopy. In the absence of alarm symptoms, most patients should undergo noninvasive testing for H-pylo ri infection with a serologic, urea breath, or stool antigen test. Factors to consider in selection of appropriate testing include reliability , specificity, sensitivity, cost, and local access and expertise. As a gene ral rule, physicians should choose a test that has the best accuracy for th e level of testing expertise available. The basic principle underlying test ing for H-pylori is that patients should not undergo testing unless the phy sician is willing to treat on the basis of a positive test result. In patie nts who receive treatment, confirmation of cure is important for preventing further morbidity and reducing risk of transmission of infection.