Peptic ulcer laboratory tests
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Diagnosis |
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Treatment |
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Case Studies |
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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Guidlines for factors that predict the successful eradication when treating H. pylori infection |
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Guidelines to document H. pylori antimicrobial resistance in the North America |
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Guidelines for evaluation and testing of H. pylori antibiotic resistance |
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Guidelines for when to test for treatment success after H. pylori eradication therapy |
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Guidelines for penicillin allergy in patients with H. pylori infection |
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Peptic ulcer laboratory tests On the Web |
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American Roentgen Ray Society Images of Peptic ulcer laboratory tests |
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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.
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 | 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 |
| 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.[3]
References
- ↑ 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.
- ↑ 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.
- ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.