Peptic ulcer other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: : Manpreet Kaur, MD [2]

Overview

Testing of H.pylori infection is very important for treating ulcers. H.pylori is tested by 2 methods, invasive and non-invasive. Rapid urease testing is invasive test which is used as diagnostic study of choice. Stool monoclonal antigen test is one of the non-invasive test which is used to diagnose active infection.

Other diagnostic studies

Testing of H.pylori infection is very important for treating ulcers.H.pylori is tested by 2 methods : invasive and non-invasive tests.^[1]^[2]

Invasive tests

Invasive tests are diagnostic of H.pylori infections
This includes endoscopy with biospy,histology and culture helps to diagnose peptic ulcer disease and ruling out cancer
Rapid urease testing is diagnostic study of choice^[3] ^[4]^[5]^[6]^[7]^[8]

Diagnostic testing for *H. pylori* infection
Endoscopic testing	Prerequisites
Rapid urease testing	Patients who have not been on a PPI within 1-2 weeks or an antibiotic or bismuth within 4 weeks of endoscopy
Histology	Patients who have been taking a PPI, antibiotics, or bismuth, endoscopic testing should include biopsies from the gastric body and antrum
Culture and Polymerase Chain Reaction	Not routinely recommended

Noninvasive tests

Urea breath test (carbon 13) tests:Urea breath test used to document eradication therapy and should be performed four to six weeks after completion of eradication therapy
- Proton pump inhibitors (PPIs) should be stopped for two weeks before the test
- Requires the ingestion of urea labeled with the nonradioactive isotope Carbon 13 or Carbon 14
Stool monoclonal antigen tests:
- Detects active infection and is used as a test of cure
- PPIs should be stopped for two weeks before testing
- Test is done by following methods:^[9]^[10]^[11]^[12]^[13]
  - Enzyme immunoassay
  - Immunochromatography
  - Antibody tests

Non-invasive testing		Comments
Urea breath tests		Provide reliable means of identifying active H. pylori infection before antibiotic treatment and is the most reliable nonendoscopic test to document eradication of infection
Serological testing		Limited use in low prevalence H. pylori populations
Stool monoclonal antigen	Enzyme immunoassay	Used to detect active infection and can be used to document eradication of infection
	Immunochromatography
	Antibody tests

References

↑ Chey WD, Wong BC, Practice Parameters Committee of the American College of Gastroenterology (2007). “American College of Gastroenterology guideline on the management of Helicobacter pylori infection”. Am J Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.
↑ Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH (1996). “Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard”. Am. J. Gastroenterol. 91 (10): 2125–9. PMID 8855734.
↑ Lieberman D, Fennerty MB, Morris CD, Holub J, Eisen G, Sonnenberg A (2004). “Endoscopic evaluation of patients with dyspepsia: results from the national endoscopic data repository”. Gastroenterology. 127 (4): 1067–75. PMID 15480985.
↑ Delaney B, Ford AC, Forman D, Moayyedi P, Qume M (2005). “Initial management strategies for dyspepsia”. Cochrane Database Syst Rev (4): CD001961. doi:10.1002/14651858.CD001961.pub2. PMID 16235292.
↑ Lieberman D, Fennerty MB, Morris CD, Holub J, Eisen G, Sonnenberg A (2004). “Endoscopic evaluation of patients with dyspepsia: results from the national endoscopic data repository”. Gastroenterology. 127 (4): 1067–75. PMID 15480985.
↑ Marmo R, Rotondano G, Piscopo R, Bianco MA, Russo P, Capobianco P, Cipolletta L (2005). “Combination of age and sex improves the ability to predict upper gastrointestinal malignancy in patients with uncomplicated dyspepsia: a prospective multicentre database study”. Am. J. Gastroenterol. 100 (4): 784–91. doi:10.1111/j.1572-0241.2005.40085.x. PMID 15784019.
↑ Talley NJ, Vakil N, Practice Parameters Committee of the American College of Gastroenterology (2005). “Guidelines for the management of dyspepsia”. Am J Gastroenterol. 100 (10): 2324–37. doi:10.1111/j.1572-0241.2005.00225.x. PMID 16181387.
↑ Mamel JJ (1991). “Use of endoscopy in peptic ulcer disease”. Med. Clin. North Am. 75 (4): 841–51. PMID 2072790.
↑ Korkmaz H, Kesli R, Karabagli P, Terzi Y (2013). “Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection”. Helicobacter. 18 (5): 384–91. doi:10.1111/hel.12053. PMID 23551920.
↑ Odaka T, Yamaguchi T, Koyama H, Saisho H, Nomura F (2002). “Evaluation of the Helicobacter pylori stool antigen test for monitoring eradication therapy”. Am. J. Gastroenterol. 97 (3): 594–9. doi:10.1111/j.1572-0241.2002.05535.x. PMID 11922552.
↑ Shimoyama T, Sawaya M, Ishiguro A, Hanabata N, Yoshimura T, Fukuda S (2011). “Applicability of a rapid stool antigen test, using monoclonal antibody to catalase, for the management of Helicobacter pylori infection”. J. Gastroenterol. 46 (4): 487–91. doi:10.1007/s00535-011-0371-4. PMID 21264478.
↑ Erzin Y, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, Kocazeybek B (2005). “Evaluation of two enzyme immunoassays for detecting Helicobacter pylori in stool specimens of dyspeptic patients after eradication therapy”. J. Med. Microbiol. 54 (Pt 9): 863–6. doi:10.1099/jmm.0.45914-0. PMID 16091438.
↑ Asfeldt AM, Løchen ML, Straume B, Steigen SE, Florholmen J, Goll R, Nestegard O, Paulssen EJ (2004). “Accuracy of a monoclonal antibody-based stool antigen test in the diagnosis of Helicobacter pylori infection”. Scand. J. Gastroenterol. 39 (11): 1073–7. doi:10.1080/00365520410007944. PMID 15545164.

Template:WikiDoc Sources

[pmid17608775-1] Chey WD, Wong BC, Practice Parameters Committee of the American College of Gastroenterology (2007). “American College of Gastroenterology guideline on the management of Helicobacter pylori infection”. Am J Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.

[pmid8855734-2] Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH (1996). “Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard”. Am. J. Gastroenterol. 91 (10): 2125–9. PMID 8855734.

[pmid15480985-3] Lieberman D, Fennerty MB, Morris CD, Holub J, Eisen G, Sonnenberg A (2004). “Endoscopic evaluation of patients with dyspepsia: results from the national endoscopic data repository”. Gastroenterology. 127 (4): 1067–75. PMID 15480985.

[pmid16235292-4] Delaney B, Ford AC, Forman D, Moayyedi P, Qume M (2005). “Initial management strategies for dyspepsia”. Cochrane Database Syst Rev (4): CD001961. doi:10.1002/14651858.CD001961.pub2. PMID 16235292.

[pmid154809852-5] Lieberman D, Fennerty MB, Morris CD, Holub J, Eisen G, Sonnenberg A (2004). “Endoscopic evaluation of patients with dyspepsia: results from the national endoscopic data repository”. Gastroenterology. 127 (4): 1067–75. PMID 15480985.

[pmid15784019-6] Marmo R, Rotondano G, Piscopo R, Bianco MA, Russo P, Capobianco P, Cipolletta L (2005). “Combination of age and sex improves the ability to predict upper gastrointestinal malignancy in patients with uncomplicated dyspepsia: a prospective multicentre database study”. Am. J. Gastroenterol. 100 (4): 784–91. doi:10.1111/j.1572-0241.2005.40085.x. PMID 15784019.

[pmid16181387-7] Talley NJ, Vakil N, Practice Parameters Committee of the American College of Gastroenterology (2005). “Guidelines for the management of dyspepsia”. Am J Gastroenterol. 100 (10): 2324–37. doi:10.1111/j.1572-0241.2005.00225.x. PMID 16181387.

[pmid2072790-8] Mamel JJ (1991). “Use of endoscopy in peptic ulcer disease”. Med. Clin. North Am. 75 (4): 841–51. PMID 2072790.

[pmid23551920-9] Korkmaz H, Kesli R, Karabagli P, Terzi Y (2013). “Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection”. Helicobacter. 18 (5): 384–91. doi:10.1111/hel.12053. PMID 23551920.

[pmid11922552-10] Odaka T, Yamaguchi T, Koyama H, Saisho H, Nomura F (2002). “Evaluation of the Helicobacter pylori stool antigen test for monitoring eradication therapy”. Am. J. Gastroenterol. 97 (3): 594–9. doi:10.1111/j.1572-0241.2002.05535.x. PMID 11922552.

[pmid21264478-11] Shimoyama T, Sawaya M, Ishiguro A, Hanabata N, Yoshimura T, Fukuda S (2011). “Applicability of a rapid stool antigen test, using monoclonal antibody to catalase, for the management of Helicobacter pylori infection”. J. Gastroenterol. 46 (4): 487–91. doi:10.1007/s00535-011-0371-4. PMID 21264478.

[pmid16091438-12] Erzin Y, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, Kocazeybek B (2005). “Evaluation of two enzyme immunoassays for detecting Helicobacter pylori in stool specimens of dyspeptic patients after eradication therapy”. J. Med. Microbiol. 54 (Pt 9): 863–6. doi:10.1099/jmm.0.45914-0. PMID 16091438.

[pmid15545164-13] Asfeldt AM, Løchen ML, Straume B, Steigen SE, Florholmen J, Goll R, Nestegard O, Paulssen EJ (2004). “Accuracy of a monoclonal antibody-based stool antigen test in the diagnosis of Helicobacter pylori infection”. Scand. J. Gastroenterol. 39 (11): 1073–7. doi:10.1080/00365520410007944. PMID 15545164.

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