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Internal Medicine
ο Moreover, the incidence of MALT lymphoma (MALT=mucosa-associated
lymphatic tissue) is increased in PUD.
ο Treating H. pylori might cure lymphoma, but chemotherapy or radical surgery
must be used when such treatment fails to cure the tumour.
ο For adenocarcinoma, surgery is always treatment of choice
Diagnosis of PUD
1) Barium examination of the upper gastrointestinal tract: sensitivity of this
investigation to detect ulcers ranges from 70 – 90%
2) Endoscopy: is most sensitive and specific method for the diagnosis of PUD.
a) Direct visualization and photographic documentation of the ulcer is possible.
b) Permits mucosal biopsy for detection of H. pylori infection.
c) Provides baseline reference for the assessment of ulcer healing.
3) Tests for H. pylori There are two categories of tests for the diagnosis of this bacterium:
Invasive tests (endoscopy required)
Rapid urease test
Non invasive tests
Urea breath test - simple, rapid; useful for early follow up, false negative with
recent therapy.
Serology – inexpensive, convenient, not useful for early follow-up
Objectives of treatment:
Relief of symptoms (pain, dyspepsia)
Eradication of H. pylori to prevent recurrence
Promote ulcer healing
Medical treatment
I. Treatment of H. pylori (see table VII-2-2)
Indications: the following diseases with documented H. pylori infection
MALT lymphoma