Management of Chronic Peptic Duodenitis

Initial Assessment and Testing

The American Gastroenterological Association recommends testing for Helicobacter pylori infection using either a stool antigen test or carbon-urea breath test, which have similar accuracy to rapid urease testing of biopsies 1
The American Gastroenterological Association advises against H. pylori serology testing as it has lower specificity compared to other non-invasive tests 1

The American College of Gastroenterology strongly recommends eradication therapy for H. pylori-positive patients with high-quality evidence 2, 3
Eradication therapy is efficacious for H. pylori-positive patients with functional dyspepsia, though adverse events are more common than with control therapy 4
The American College of Gastroenterology recommends confirmation of successful eradication only in patients with increased risk of gastric cancer 2
The American College of Gastroenterology strongly recommends proton pump inhibitor (PPI) therapy for all patients, regardless of H. pylori status, with high-quality evidence 2, 3
The use of the lowest effective dose that controls symptoms is recommended as there is no apparent dose-response relationship 2

Regular aerobic exercise is strongly recommended, though based on very low-quality evidence, to help manage symptoms 2
Avoiding specific food triggers that may exacerbate symptoms is advised 4
Caution against overly restrictive diets that could lead to nutritional deficiencies is recommended 4

A trial of withdrawal or reduction to the lowest effective dose is considered if symptoms are controlled with initial therapy 5
Referral to gastroenterology in secondary care is considered for patients with persistent symptoms despite optimization of therapy 2
Indications for referral include diagnostic doubt, severe symptoms, refractoriness to first-line treatments, or patient request for specialist opinion 2

Unnecessary and repeated endoscopies should be avoided if the diagnosis is established and there are no alarm symptoms 2
Gastric emptying testing or 24-hour pH monitoring should not be undertaken routinely in patients with typical symptoms 2
Opioids and surgery should be avoided in patients with severe or refractory symptoms to minimize iatrogenic harm 4