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 H. 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 methods of diagnostic testing for H. pylori can be classified into those that do and those that do not require endoscopy:[3]

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.

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.
  3. 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.


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