First-line therapy for routine peptic duodenal ulcer disease includes:

C. Evaluation for Helicobacter pylori.

DISCUSSION: Vagotomy and antrectomy is the definitive surgical therapy for peptic ulcer disease but should be applied only for complications of the disease or after refractory disease has been documented. Biopsy of routine peptic duodenal ulcer is not indicated to rule out malignancy except in special circumstances, such as an endoscopic appearance typical of malignancy. H. pylori is found in a large percentage of peptic ulcer patients, and treatment alters the rate of recurrence if therapy is directed toward reduction of H. pylori in addition to acid. Measurement of serum gastrin is recommended for patients with resistant or persistent peptic ulcer disease for patients undergoing surgery for peptic ulcer disease. The Sippy diet has not been recommended clinically for years. Formerly it was recommended as a bland diet that would not exacerbate peptic ulcer disease. It is now known that these diets are heavily calcium-laden and probably exacerbate peptic ulcer disease.