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October 9, 1996

Practice Guidelines for Treatment of Peptic Ulcer Disease

Author Affiliations

The New York Hospital-Cornell Medical Center New York, NY
Columbia University College of Physicians and Surgeons New York, NY

JAMA. 1996;276(14):1136. doi:10.1001/jama.1996.03540140024012

To the Editor.  —Dr Soll1 suggested that gastric biopsy material obtained for histologic analysis should be discarded if the urease test was positive for H pylori. We find it appalling how much physicians nowadays are willing to compromise for the sake of cost containment. Gastroenterologists who feel tempted to dispose of gastric tissue specimens from patients with peptic ulcer disease should be reminded that they may be forgoing a golden opportunity to detect gastric carcinoma and lymphoma at the early stages. To date, abundant evidence exists supporting the role of H pylori infection in the development of gastric dysplasia and carcinoma.2-4 In 1994, the existing evidence was so strong that the World Health Organization and the International Agency for Research on Cancer decided to classify H pylori as a definite carcinogen for the human stomach.5The practice of discarding gastric tissue designated for histopathologic analysis negates much of our effort