Peptic Ulcer Disease

Pt with h/o NSAID use presents with dyspepsia. Denies unexplained weight loss, dysphagia/odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding. No conjunctival pallor, abdominal mass on exam.

• Obtain H. pylori fecal antigen testing

• [Pt <55 y/o with no alarm symptoms; endoscopy not indicated]

• Triple therapy x14 days: PPI 20mg BID, amoxicillin 1g BID, clarithromycin 500mg BID

• Follow-up in 1 month and repeat fecal antigen testing if symptoms persist

• Failed triple therapy; start PPI 20mg BID, metronidazole 500mg TID, tetracycline 500mg 4x daily, bismuth sbsalicylate 524mg 4x daily