AFP Clinical Answers

H. pylori, Heart Failure, Acupuncture, Injections for Tendinopathy, Hirsutism


Am Fam Physician. 2020 Feb 1;101(3):143.

Which noninvasive diagnostic test provides the most accurate diagnosis of Helicobacter pylori infection?

The serology, stool antigen, and urea breath tests all have similar high positive predictive values but vary in their false-negative rate. When compared with serology or stool antigen tests, the urea breath test has the highest diagnostic accuracy to identify H. pylori. Results are applicable for patients without a history of gastrectomy or recent use of antibiotics or proton pump inhibitors.

Do therapies that help patients who have HFrEF also improve outcomes in patients who have HFpEF?

The therapies that are beneficial for heart failure with reduced ejection fraction (HFrEF) have less benefit in heart failure with preserved ejection fraction (HFpEF). Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have not been shown to change the morbidity or mortality in patients with HFpEF. Beta blockers may positively affect cardiovascular mortality, but they do not improve hospitalizations or all-cause mortality. Mineralocorticoid receptor antagonists reduce hospitalizations for patients with HFpEF without affecting mortality.

What is the evidence for acupuncture in treating low back pain, knee osteoarthritis pain, and headaches?

Both acupuncture and sham acupuncture show large placebo responses in studies, so acupuncture benefit is compared with sham. For chronic low back pain, acupuncture is significantly more clinically effective in the short term than sham acupuncture. For acute back pain, acupuncture is slightly more clinically effective than sham acupuncture or anti-inflammatory medications, but the differences are of borderline clinical significance. For knee osteoarthritis, acupuncture and sham acupuncture both have clinically significant effects. Acupuncture can be an effective treatment for knee osteoarthritis in the short term. Acupuncture is effective in



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