Final answer:
When mid-epigastric pain or ulcers do not respond to H. pylori eradication therapy, an endoscopy should be performed to explore further causes, such as atypical ulcers or resistance to treatment. The treatment usually involves a combination of antibiotics and acid-suppressing drugs, with alternative treatments considered if standard therapy is unsuccessful.
Step-by-step explanation:
If mid-epigastric pain or ulcers do not improve with the eradication of H. pylori, it might indicate a more persistent or severe issue beyond a simple peptic ulcer. In such cases, the recommended workup would include endoscopy to allow for direct visualization of the stomach and duodenum. This can help to determine the presence of large, multiple, or atypically located ulcers, and also check for other potential problems such as malignancy.
Treatment for peptic ulcers typically involves a combination of antibiotics to target H. pylori and acid-decreasing medications. However, should these treatments fail or if there is resistance to antibiotics, it may be necessary to explore other treatment options, including higher doses or different combinations of antibiotic therapy, or even surgical intervention if there is a perforation. It is also important to review the patient's use of non-steroidal anti-inflammatory drugs (NSAIDs) and to manage any risk factors, such as smoking or stress that could contribute to ulcer formation.