Peptic ulcer laboratory tests

Jump to navigation Jump to search

Peptic ulcer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Peptic Ulcer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Upper GI Endoscopy

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Endoscopic management
Surgical management

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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

Guidelines for the salvage therapy

Peptic ulcer laboratory tests On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Peptic ulcer laboratory tests

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Peptic ulcer laboratory tests

CDC on Peptic ulcer laboratory tests

Peptic ulcer laboratory tests in the news

Blogs on Peptic ulcer laboratory tests

to Hospitals Treating Peptic ulcer

Risk calculators and risk factors for Peptic ulcer laboratory tests

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

Overview

Lab tests for the diagnosis of peptic ulcer can be divide in endoscopic and non-endoscopic tests. The most common endoscopic tests include rapid urease testing, histology, and culture and Polymerase Chain Reaction (PCR). The most common non-endoscopic test include urea breath test, antibody testing, and monoclonal fecal antigen.

Algorithm for the Approach to Dyspepsia

 
 
 
 
 
Age ≥ 55 or ⊕ alarm features?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Endoscopy
 
 
 
 
 
 
 
H. pylori prevalence?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High
 
 
 
 
 
 
 
Low
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Test-and-treat strategy ± acid suppression
 
 
 
 
 
 
 
Acid suppression trial
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If eradication therapy is indicated
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Clarithromycin resistance ≥ 20%
 
 
 
 
 
 
 
Clarithromycin resistance < 20%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Quadruple or sequential therapy
 
 
 
 
 
 
 
PCA or PCM or Bismuth quadruple therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PLA
 
 
 
 
 
 
 
Bismuth quadruple therapy or PLA
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Adjust Rx per susceptibility test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider endoscopy if treatment fails
 
 
 
 
 
 
 
 
 
 


Laboratory Findings

  • Approach of patients <55 years, depending of the H. pylori (H. pylori) prevalence (≥10%):[1]
    • Test and treat for H. pylori using a validated noninvasive test and a trial of acid suppression if eradication is successful but symptoms do not resolve OR
    • Empiric trial of acid suppression with a proton pump inhibitor (PPI) for 4-8 weeks.
  • The methods of diagnostic testing for H. pylori can be classified into those that do and those that do not require endoscopy:[2]

Endoscopic testing:Endoscopy with biopsy is recommended to diagnose cancer and other causes in patients 55 years or older, or with one or more alarm symptoms such asunexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia, or jaundice[3]

In patients who have not been taking a PPI within one to two weeks of endoscopy, or bismuth or an antibiotic within four weeks, the rapid urease test performed on the biopsy specimen provides an accurate, inexpensive means of diagnosing H. pylori infection.2 Patients who have been on these medications will require histology, with or without rapid urease testing. Culture and polymerase chain reaction allow for susceptibility testing but are not readily available for clinical use in the United States.

Diagnostic testing for H. pylori infection
Endoscopic testing Comments
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
Diagnostic testing for H. pylori infection
Nonendoscopic 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
Antibody testing Limited use in low prevalence H. pylori populations
Monclonal fecal antigen Also a reliable nonendoscopic test to document eradication of infection
  • The possibility of other causes of ulcers, notably malignancy (gastric cancer) needs to be kept in mind. This is especially true in ulcers of the greater (large) curvature of the stomach; most are also a consequence of chronic H. pylori infection.
  • Esophagogastroduodenoscopy: indicated in patients >55 years, those whose symptoms do not respond to medications, those with alarm symptoms (bleeding, weight loss, chronicity, persistent vomiting.[4]

References

  1. 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.
  2. 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.
  3. Bowrey DJ, Griffin SM, Wayman J, Karat D, Hayes N, Raimes SA (2006). "Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked". Surg Endosc. 20 (11): 1725–8. doi:10.1007/s00464-005-0679-3. PMID 17024539.
  4. Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.


Template:WikiDoc Sources