The Patient with Dyspepsia
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For patients with dyspepsia younger than 50 years of age without alarm symptoms, empiric treatment with a PPI (if the patient is from an area with a low prevalence of H pylori) or a test-and-treat strategy for H pylori (if the patient is from a developing country where infection prevalence is high) is warranted. The efficacy of improving dyspepsia symptoms in patients with dyspepsia is controversial, with conflicting results being reported. If testing for the organism is negative, then a trail of PPI therapy could represent a prudent approach. Data with H2 blockers has been inconsistent concerning symptom relief for dyspepsia and the drugs are not FDA-approved or formally recommended for this indication.
Fecal antigen testing has a predictive value, sensitivity, specificity exceeding 90%. The results are positive in the initial stages of infection.
Diarrhea, belching, and mild mid-epigastric tenderness with palpation are not considered alarm symptoms.