kaplan H.pylori question

[playingfrombehind]

---

Members do not see this ad.

Question ID# s30160 from Kaplan step 3 bank

Question: New patient here for 2nd opinion about management of her heartburn symptoms from GERD. Had chest discomfort and taste disturbance for several months. Symptoms promptly relieved by PPI, omeprazole. Prefers no medications on regular basis but every time she stops PPI she develops discomfort within 2-3 days. The serology test of blood, breath test, and stool antigen for H.pyloriare all positive. What is your advice to her.

A) triple therapy for 2 weeks
B) metronidazole, tetra + PPI for 2eeks
C) scope and treat H.pylori only if biopsy (+)
D) await sensitivity testing before treating
E) PPI alone as needed

Why is the answer "E"? I would have chosen "A" According to the explanation.... H.pylori does not need to be treated if found in association with GERD as it is not cause of GERD. A large portion of general population is colonized with H.pylori and it requires no treatment unless PUD, gastritis, MALT, etc.

 

[Phloston]

Question ID# s30160 from Kaplan step 3 bank

Question: New patient here for 2nd opinion about management of her heartburn symptoms from GERD. Had chest discomfort and taste disturbance for several months. Symptoms promptly relieved by PPI, omeprazole. Prefers no medications on regular basis but every time she stops PPI she develops discomfort within 2-3 days. The serology test of blood, breath test, and stool antigen for H.pyloriare all positive. What is your advice to her.

A) triple therapy for 2 weeks
B) metronidazole, tetra + PPI for 2eeks
C) scope and treat H.pylori only if biopsy (+)
D) await sensitivity testing before treating
E) PPI alone as needed

Why is the answer "E"? I would have chosen "A" According to the explanation.... H.pylori does not need to be treated if found in association with GERD as it is not cause of GERD. A large portion of general population is colonized with H.pylori and it requires no treatment unless PUD, gastritis, MALT, etc.

Since H. pylori is not a cause of GERD and the patient is otherwise asymptomatic apart from the GERD, that means the patient is asymptomatically colonized with H. pylori, so we don't treat. This was also a concept that showed up in MTB3 although your line of thinking is smart and reasonable. UWorld hammered the dyspepsia algorithm, where a scope needs to be done on a patient ≥55 or with alarm findings (B-Sx, dysphagia/odynophagia, lymphadenopathy, abdominal mass, fatigue/anaemia, persistent vomiting, haematemesis, family gastric ulcers, Japanese). And whether or not the patient needs a scope, one must consider if the patient is from a country of high (>10%) H. pylori prevalence. If no (America), give 4-6 weeks of PPI therapy. If yes (e.g., Mexico), do H. pylori test first. If negative, give 4-6 weeks PPI Tx. If positive, Tx for H. pylori. If the PPI therapy alone doesn't work in either, consider H. pylori again.

The point being, dyspepsia is considered the Dx only after GERD and NSAID use have been ruled out first. Then H. pylori Tx can be considered downstream in the dyspepsia Tx algorithm. But if you know the patient has GERD or NSAID use and that is the sole source of the issue, H. pylori Tx isn't needed.