1. For the initial diagnosis, serologic testing is recommended for most patients with uncomplicated PUD. Patients over the age of 50 and patients with gastrointestinal bleeding, weight loss, vomiting or severe pain, or patients who do not respond to therapy within two weeks should be evaluated with endoscopy.
2. Serologic tests have a sensitivity of 80-95 % and specificity is 80-96%. Serology is relatively inexpensive. H pylori antibodies persist for several years after H. pylori eradication. Therefore, serology is useful in the initial diagnosis of H. priori infection, but it is not useful as a test of cure following antibiotic treatment.
3. Breath tests using C-13-labeled urea are more expensive than serology but have a sensitivity of >95% and a specificity >95%. The urea breath test can be used for initial diagnosis and as a test of cure.
B. Endoscopic testing for H pylori infection is the most sensitive method of detecting gastric and duodenal ulceration.
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