H Pylori 3-question Quiz

The initial approach to management of functional dyspepsia may include test and treat for Helicobacter pylori and a course of empiric PPI.

Which of the following medications have also demonstrated a therapeutic effect in the treatment of functional dyspepsia?

A. Baclofen

B. Peppermint oil

C. Buspirone

D. Tramadol

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Answer: C. Buspirone

The choice of initial approach to a patient with functional dyspepsia will depend on the pretest probability of H pylori in the population. If the pretest probability is low in certain areas, then a PPI approach may be a better option to start. If these two options fail to improve symptoms, buspirone has been shown in a small randomized cross over study to improve overall dyspepsia symptoms. Buspirone is a 5-hydroxytrypatamine receptor antagonist. Its acts by increasing gastric accommodation, which is believed to play a role in the development of symptoms of dyspepsia, such as bloating and early satiety.

H pylori is a risk factor for all the following conditions except?A. Gastric adenocarcinoma

B. Gastroesophageal reflux disorder (GERD)

C. Mucosa-associated lymphoid tissue (MALT) lymphoma

D. Duodenal ulcers

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Answer: B. GERD

Helicobacter pylori is a World Health Organization category 1 carcinogen. It is known to be associated with both gastric adenocarcinoma and mucosal associated lymphoid tissue. Additionally, H pylori is a major cause of peptic ulcer disease, as are non-steroidal anti-inflammatory drugs. H pylori is not a risk factor for GERD. There are some data to suggest that the treatment of H pylori may actually worsen reflux symptoms.

A 48-year-old woman presents with several months of hoarseness, unresponsive to over-the-counter antacids. The symptoms appear worse in the morning, but can occur all day. She has minimal heartburn and no regurgitation. She denies dysphagia and has never had an upper endoscopy.

Which of the following would be the next step?

A. Trial of high dose PPI for 8 weeks

B. Upper endoscopy

C. 24-hour pH with impedance

D. Barium esophagram

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Answer: A. Trial of high dose PPI for 8 weeks

The patient’s symptom of hoarseness may be a representation of laryngopharyngeal reflux or LPR. It remains unclear whether GERD is the main cause of LPR or plays a contributing role in the presence of atypical reflux symptoms such as hoarseness. The other major causes of this symptom include allergic triggers. Assuming reflux is at least a contributor, the best course of action is an initial high dose trial of PPI for 8 weeks. If response is seen, then the dosage should be titrated to the lowest effective dose. Upper endoscopy and barium swallow have very low yield in the initial evaluation of hoarseness. A 24-hour pH with impedance is the gold standard for the diagnosis of reflux and should be considered after a dose of PPI is tried. If symptoms persist, then testing off PPI would be indicated to rule out GERD. On the other hand, if a partial response is seen, then testing on PPI can be performed to rule out nonacid reflux as a potential cause.