Which patient should be tested for Helicobacter pylori infection without the need for endoscopy?

Testing for Helicobacter pylori infection without requiring endoscopy is typically indicated in patients exhibiting symptoms that are consistent with peptic ulcer disease or those who are at risk for complications related to H. pylori. In this case, the patient experiencing burning after eating aligns with typical symptoms associated with peptic ulcers, which necessitate screening for H. pylori.

Patients presenting with such symptoms can often be evaluated through non-invasive testing methods, such as a breath test, stool antigen test, or serology, rather than immediate endoscopy, especially in the absence of alarm symptoms like significant weight loss, gastrointestinal bleeding, or anemia. This makes the testing both practical and efficient while allowing for appropriate management of the condition.

Other patients listed may have symptoms that could suggest a more complex underlying issue or may not fit the typical symptom profile that warrants immediate testing for H. pylori without further evaluation, like endoscopy, particularly in the elderly or those with chronic gastrointestinal conditions where a more thorough investigation is prudent.