help please

[drake19]

A 35-year-old male with epigastric pain and positive serology for H. pylori was treated with triple therapy. Several months later, he was asymptomatic but his serology was positive. Which one of the following is the best management strategy?


1) repeat the triple therapy

2) perform endoscopy

3) repeat serology in three months

4) test his spouse for H. pylori

5) reassure and counsel

i'm guessing endoscopy? according to answers reassure and counsel. I checked uptodate where it says under eradication confirmation: eradication may be confirmed by a urea breath test, fecal antigen test, or upper endoscopy performed four weeks or more after completion of therapy

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[Omar Little]

The question is assessing if you understand that H. Pyolori serology is only useful for an initial diagnosis and not helpful for follow up. The patient's symptoms have resolved and serology will be positive forever, therefore just reassure the patient.

http://emedicine.medscape.com/article/176938-workup

 

[ChessMaster3000]

Yep, reassure and counsel.

Havent read the uptodate, but I think that if the patient still has symptoms after treatment, and you want to confirm that it's not the pylori causing the problems, those ar e the ways you can confirm eradication.

 

[MrGrrrMonster]

Yep, reassure and counsel.

I second this. The patient has improved symptoms, and serology (IgG) will remain positive. No use sticking a scope down their throat and sniping off a piece of their stomach lining.

 

[treadmass]

Is there any other usmle review source besides uptodate or emedicine where it talks about counseling and reassurance for H.Pylori serology and follow-up? I'm having trouble finding it in some of the review books and didn't see anything about it in UW yet.

What if a new option was given to the question in where "counsel and reassure" was also there?
repeat stool and/or repeat breath test?