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

Guidelines for the salvage therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

  • Etiological classification of peptic ulcers:[1]
    • Positive for Helicobacter pylori infection.
    • Drug NSAID-induced.
    • H pylori and NSAIDs positive.
    • H pylori and NSAIDs negative (requires search for other causes).
  • Approach of patients <55 years, depending of the Helicobacter pylori (H. pylori) prevalence (≥10%):[2]
    • 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.

Laboratory Findings

The diagnosis of Helicobacter pylori can be by:

  • Breath testing (does not require EGD);
  • Direct culture from an EGD biopsy specimen;
  • Direct detection of urease activity in a biopsy specimen;
  • Measurement of antibody levels in blood (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy.

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. pyloriinfection.

References

  1. Malfertheiner P, Chan FK, McColl KE (2009). "Peptic ulcer disease". Lancet. 374 (9699): 1449–61. doi:10.1016/S0140-6736(09)60938-7. PMID 19683340.
  2. 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.


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