Diagnostic studies peptic ulcer disease

• Testing for H. pylori: stool Ag, urea breath testing (UBT) or EGD + rapid urease test (RUT) False ⊖ Ag, UBT, RUT if on abx, bismuth, PPI; ∴ stop prior to testing if possible Serology: ↓ utility, useful only to exclude infection in lower prevalence areas

• EGD (definitive dx): if fail empiric Rx or alarm features (see “GERD”); bx GU to r/o malig & H. pylori; repeat EGD in 6–12 wk if >2 cm, malig features, risk factors for gastric cancer (ie, ⊕ FHx, ⊕ H. pylori, atrophic gastritis, metaplasia on bx, >50 y), or sx persist