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Helicobacter pylori–Related Disease
Guidelines for Testing and Treatment
Walter L. Peterson, MD;
A. Mark Fendrick, MD;
David R. Cave, MD, PhD;
David A. Peura, MD;
Susan M. Garabedian-Ruffalo, PharmD;
Loren Laine, MD
Arch Intern Med. 2000;160:1285-1291.
Objective To develop practical guidelines for the treatment of patients with suspected and documented Helicobacter pylori–related gastroduodenal diseases.
Methods A panel of physicians with expertise in H pylori reviewed, critically appraised, and synthesized the literature on assigned topics and presented their overviews to the panel. Consensus was obtained in controversial areas through discussion.
Results and Conclusions The panel recommended testing for H pylori in patients with active ulcers, a history of ulcers, or gastric mucosa-associated lymphoid tissue lymphomas. Young, otherwise healthy patients with ulcerlike dyspepsia and those with a family history or fear of gastric cancer may also undergo H pylori testing. Nonendoscopic methods are preferred for H pylori diagnosis. Dual medication regimens should not be used for therapy; twice-daily triple therapy with a proton pump inhibitor or ranitidine bismuth citrate, clarithromycin, and amoxicillin for 10 to 14 days is an appropriate therapy. Posttreatment assessment of H pylori status using urea breath testing should be considered in patients with a documented history of ulcer disease or with persistent symptoms.
From the Medical Service, Dallas VA Medical Center, and the Department of Medicine, University of Texas Southwestern Medical School at Dallas (Dr Peterson); the Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor (Dr Fendrick); the Department of Medicine, Tufts University Medical School, Boston, Mass (Dr Cave); Department of Medicine, University of Virginia, Charlottesville (Dr Peura); and the Department of Clinical Pharmacy Practice (Dr Garabedian-Ruffalo) and the School of Medicine, Department of Medicine (Dr Laine), University of Southern California, Los Angeles.
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