In developed countries, the use of test and treat strategy is declining for younger patients presenting with dyspepsia. In developing countries, as the rates of ulcer or gastric cancer are high, the more appropriate initial approach in the diagnosis of H. pylori infection in developing countries are an empirical test-and-treat approach or initial endoscopy.

• The use of a test-and-treat strategy is declining for younger patients presenting with dyspepsia.
• The preferred first-line treatment when the H. pylori prevalence is <20% is the immediate use of an antisecretory drug (proton-pump inhibitor).
• For those aged 50 and older, endoscopy to exclude an upper gastrointestinal malignancy and testing for H. pylori infection if no malignancy is found remains a logical approach.
• Testing for H. pylori infection should be carried out in younger patients in countries with a high risk of gastric cancer.

AS the rates of ulcer or gastric cancer are high, the more appropriate initial approach in diagnosis of H. pylori infection in developing countries are:

• An empirical test-and-treat approach

or

• Initial endoscopy