Does a 29-year-old female with a single episode of gastritis, now resolved with Proton Pump Inhibitor (PPI) therapy, require a gastroscopy or further investigation?

Management of a 29-Year-Old Female with Resolved Gastritis

A 29-year-old female with a single episode of gastritis that has resolved with PPI therapy does not require gastroscopy or further investigation at this time.

Rationale for No Further Investigation

Clinical Context

• Young patient (29 years old)
• Single episode of gastritis
• Complete resolution of symptoms with PPI therapy
• No ongoing PPI requirement
• No alarm symptoms mentioned

Evidence-Based Approach

According to the AGA Clinical Practice Update on the personalized approach to GERD management 1, diagnostic testing such as endoscopy is primarily indicated in specific scenarios:

1. When alarm symptoms are present
2. When symptoms persist despite empirical PPI therapy
3. For long-term PPI users with unproven GERD (>12 months)

None of these scenarios apply to this patient, as:

• The patient has had complete symptom resolution
• No alarm symptoms are mentioned
• The patient is no longer requiring PPI therapy

When Endoscopy Would Be Indicated

Endoscopy would be warranted in the following circumstances:

• Alarm symptoms such as:

  • Dysphagia
  • Weight loss
  • Recurrent vomiting
  • Anemia or evidence of bleeding
  • Epigastric mass 1

• Persistent symptoms despite adequate PPI therapy (4-8 weeks of treatment) 1

• Age >50 years with chronic GERD symptoms (due to increased risk of Barrett's esophagus) 1

• Long-term PPI therapy (>12 months) without a confirmed diagnosis 1

Potential Pitfalls to Consider

Masking of H. pylori

Long-term PPI use can mask H. pylori infection 2, but this is not a concern in this patient since:

• The episode was brief
• The patient is no longer on PPI therapy
• The gastritis has resolved completely

Monitoring for Recurrence

If symptoms recur, a stepwise approach should be followed:

1. Resume PPI therapy for 4-8 weeks 1
2. If symptoms persist despite resumed PPI therapy, then endoscopy would be indicated 1
3. If symptoms resolve again with PPI therapy, taper to the lowest effective dose 1

Conclusion

Based on current guidelines, this young patient with a single resolved episode of gastritis and no ongoing PPI requirement does not need gastroscopy or further investigation. The low pre-test probability of significant pathology in this demographic without alarm symptoms does not justify the risks and costs of invasive testing.