Approach to the evaluation and management of dyspepsia in adults

H. pylori: Helicobacter pylori; NSAIDs: nonsteroidal anti-inflammatory drugs.

* Additional evaluation may be required based on symptoms (eg, abdominal imaging in patients with concurrent jaundice or pain suggestive of a biliary/pancreatic source).

¶ Gastric mucosal biopsies should be obtained at the time of upper gastrointestinal endoscopy to rule out infection with H. pylori.

Δ Eradication of H. pylori infection can be confirmed with a urea breath test, stool antigen testing, or upper endoscopy-based testing performed 4 weeks after completion of antibiotic therapy. The choice of test depends on the need for an upper endoscopy (eg, follow-up of bleeding peptic ulcer) and test availability. H. pylori serology should not be used to confirm eradication of H. pylori. Refer to UpToDate content on the diagnosis of H. pylori for details.