Peptic ulcer laboratory tests

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2017 ACG Guidelines for Peptic Ulcer Disease

Guidelines for the Indications to Test for, and to Treat, H. pylori Infection

Guidelines for First line Treatment Strategies of Peptic Ulcer Disease for Providers in North America

Guidlines for factors that predict the successful eradication when treating H. pylori infection

Guidelines to document H. pylori antimicrobial resistance in the North America

Guidelines for evaluation and testing of H. pylori antibiotic resistance

Guidelines for when to test for treatment success after H. pylori eradication therapy

Guidelines for penicillin allergy in patients with H. pylori infection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2] Manpreet Kaur, MD [3]

Overview

There is no specific diagnostic laboratory test for peptic ulcer disease but in patient with history of peptic ulcer disease, laboratory test is used to rule out bleeding.

Initial Laboratory Studies

  • There are no diagnostic laboratory findings associated with peptic ulcer disease.
  • If there is the history of peptic ulcer disease then following laboratory test can be useful:[1][2][3][4][5][6]
    • Complete blood count
    • Liver function tests
    • Serum lipase and amylase
    • Iron studies
    • Some patients with Peptic ulcer disease may have reduced serum ferritin, which is usually suggestive of bleeding which requires further endoscopy to rule out bleeding

Noninvasive tests

  • Urea breath test (carbon 13) tests:Urea breath tests require the ingestion of urea labeled with the nonradioactive isotope carbon 13 or carbon 14.Proton pump inhibitors (PPIs) should be stopped for two weeks before the test. It is used to document eradication therapy and should be performed four to six weeks after completion of eradication therapy.
  • Stool monoclonal antigen tests- it detect active infection and can be used as a test of cure. PPIs should be stopped for two weeks before testing.It can be done by following methods:[7][8][9][10][11]
    • 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

  1. Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE (1999). "Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis". Postgrad Med. 105 (3): 113–6, 121–3, 127–8 passim. doi:10.3810/pgm.1999.03.594. PMID 10086037.
  2. Rosen SD, Rogers AI (1990). "Clinical recognition and evaluation of peptic ulcer disease". Postgrad Med. 88 (5): 42–7, 51, 55. PMID 2216988.
  3. Fashner J, Gitu AC (2015). "Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection". Am Fam Physician. 91 (4): 236–42. PMID 25955624.
  4. Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE (1999). "Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis". Postgrad Med. 105 (3): 113–6, 121–3, 127–8 passim. doi:10.3810/pgm.1999.03.594. PMID 10086037.
  5. Chung CS, Chiang TH, Lee YC (2015). "A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers". Korean J. Intern. Med. 30 (5): 559–70. doi:10.3904/kjim.2015.30.5.559. PMC 4578017. PMID 26354049.
  6. Mehmedović-Redzepović A, Mesihović R, Prnjavorac B, Kulo A, Merlina K (2011). "Hematologic and laboratory parameters in patientis with peptic ulcer bleeding treated by two modalities of endoscopic haemostasis and proton pump inhibitors". Med Glas (Zenica). 8 (1): 151–7. PMID 21263414.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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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