Peptic ulcer disease, Helicobacter pylori infection and chronic gastritis
Peptic ulcer disease is associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs). If heartburn or acid regurgitation is the main symptom, the patient is likely to have gastro-oesophageal reflux disease . Determination of Helicobacter pylori antibodies, or a stool antigen or breath urea test, and the treatment of Helicobacter-positive patients without performing endoscopy is an efficient and safe approach to the management of dyspeptic patients aged less than 55 years who have no alarming symptoms. In patients with functional dyspepsia, Helicobacter pylori eradication has little or no effect on the symptoms , but Helicobacter-induced peptic ulcer disease will be treated. If dyspepsia is associated with alarming symptoms or the patient is aged more than 55 years at symptom onset, treatment should not be started before a gastroscopy is carried out. Helicobacter pylori must always be eradicated in patients with a gastric or duodenal ulcer.