Question

A 39-year-old CFO of a finance company is seen for upper abdominal discomfort. She experiences heartburn, belching, and epigastric burning pain on and off for the last several months. She does say that her food habits are irregular, due to the high stress at her job, and her caffeine intake is more than she thinks is healthy. She does not smoke or drink. She has no medical problems, and she is not taking any medications. On exam, she is afebrile, pulse is 78/min, BP 110/70, height is 5'6, and weight 135 pounds. Further exam reveals some epigastric tenderness but is otherwise normal. She is advised a trial of lansoprazole by her doctor and follow-up in 2 weeks. However, she says that she has been reading about her symptoms and is concerned about infection with helicobacter pylori. What is the most cost-effective initial measure to diagnose this?

1. Referral to gastroenterologist for endoscopy
2. Empiric treatment with triple therapy
3. Urea breath test
4. Rapid antibody test
5. Fecal antigen test

Answer 1

The most cost-effective initial diagnostic measure for the CFO concerned about Helicobacter pylori infection is the urea breath test, due to its accuracy and non-invasive nature.

Step-by-step explanation:

Many people experience indigestion or dyspepsia, which may present with upper abdominal fullness, heartburn, nausea, and belching. While it can often be alleviated with lifestyle changes such as eating more slowly or avoiding certain foods and medications, it can also be indicative of conditions like GERD or peptic ulcers. When symptoms persist, as in the case of the CFO with abdominal discomfort and concern about Helicobacter pylori infection, the most cost-effective initial diagnostic measure is a non-invasive test. In this scenario, the urea breath test, a simple and reliable test for detecting the presence of H. pylori, would be favored over an immediate endoscopy, empirical treatment, a rapid antibody test, or a fecal antigen test due to its balance of accuracy, cost, and convenience.