H pylori testing before PPIs in GERD

Should patients with symptoms of gastroesophageal reflux disease be tested for Helicobacter pylori before starting proton pump inhibitors (PPIs)?

Janusz Jankowski, MD, PhD: Categorically not. If the patients have got symptoms of lower heartburn starting in the sternum and moving up to the upper sternum, which is associated with food, posture, and response to antacids, or acid-suppressing drugs, there is a 95% chance that they have got esophageal reflux disease. So it is fair and rapid to treat the patient right away rather than wait for H pylori testing. In fact, it is more cost-effective to treat it that way as well.