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Discussion IV
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Question: What should we do with those patients who respond to the omeprazole test? When should a trial of proton pump inhibitor therapy end, or should patients receive long term therapy?
Dr Fennerty: None of the studies looked at patients in the long term. I would find the lowest effective dose that leaves patients in remission, and then continue treating with this dose.
Question: To what extent do a negative Helicobacter pylori test and a negative omeprazole test reassure the physician that the patient does not have a serious or significant disease? Would you investigate such a patient further and, if yes, how does a physician who is not reassured manage to reassure the patient that he/she does not have a serious disease?
Professor Talley: As a gastroenterologist, when such a patient comes to me of course I will investigate him/her further, because that is why patients are sent to me. We really need to ask a primary care physician whether, in a young patient who does not have alarm features, who is H pylori negative, and in whom acid …