Gastritis diagnostic test: Difference between revisions

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==Non-endoscopic diagnostic studies==
==Non-endoscopic diagnostic studies==
The non-endoscopic diagnostic testing methods for ''[[H. pylori]] include:''
*Antibody tests
*[[Urea breath test]] (UBT)
*Fecal antigen test
{| class="wikitable"  
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| colspan="4" style="background:#DCDCDC; + " |
*[[Antibody]] testing is inexpensive and widely available but poor PPV in populations with a low [[prevalence]] of ''[[H. pylori]]'' infection limits its usefulness in clinical practice.
*[[Antibody]] testing is inexpensive and widely available but a poor [[positive predictive value]] (PPV) in populations with a low [[prevalence]] of ''[[H. pylori]]'' infection limits its usefulness in clinical practice.
|-  
|-  
| colspan="4" style="background:#DCDCDC; + " |
| colspan="4" style="background:#DCDCDC; + " |
*The UBTs and fecal antigen tests provide reliable means of identifying active ''[[H. pylori]]'' infection before antibiotic therapy.  
*The UBT and fecal antigen tests provide reliable means of identifying active ''[[H. pylori]]'' infection before antibiotic therapy.  
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*The monoclonal fecal antigen test provides another nonendoscopic means of establishing ''[[H. pylori]]'' cure after antibiotic treatment.  
*The monoclonal fecal antigen test provides another non-endoscopic means of establishing ''[[H. pylori]]'' cure after antibiotic treatment.  
|-  
|-  
| colspan="4" style="background:#DCDCDC; + " |
| colspan="4" style="background:#DCDCDC; + " |
*Testing to prove ''[[H. pylori]]'' eradication appears to be most accurate if performed at least 4 wk after the completion of [[antibiotic therapy]].  
*Testing to prove ''[[H. pylori]]'' eradication appears to be most accurate if performed at least 4 wk after the completion of [[antibiotic therapy]].  
|}
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The nonendoscopic diagnostic testing methods for ''[[H. pylori]] include:''
*Antibody tests
*Urea breath test
*Fecal antigen test


===Antibody tests===
===Antibody tests===
*Antibody testing depends on the detection of ''[[H. pylori]]'' specific [[IgG]] antibodies in [[serum]], [[whole blood]], or [[urine]].<ref name="pmid11190069">{{cite journal| author=Ho B, Marshall BJ| title=Accurate diagnosis of Helicobacter pylori. Serologic testing. | journal=Gastroenterol Clin North Am | year= 2000 | volume= 29 | issue= 4 | pages= 853-62 | pmid=11190069 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11190069  }} </ref><ref name="pmid8651160">{{cite journal| author=Loy CT, Irwig LM, Katelaris PH, Talley NJ| title=Do commercial serological kits for Helicobacter pylori infection differ in accuracy? A meta-analysis. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 6 | pages= 1138-44 | pmid=8651160 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8651160  }} </ref><ref name="pmid10364016">{{cite journal| author=Chey WD, Murthy U, Shaw S, Zawadski A, Montague J, Linscheer W et al.| title=A comparison of three fingerstick, whole blood antibody tests for Helicobacter pylori infection: a United States, multicenter trial. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 6 | pages= 1512-6 | pmid=10364016 | doi=10.1111/j.1572-0241.1999.1135_x.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10364016  }} </ref>
*Antibody testing depends on the detection of ''[[H. pylori]]'' specific [[IgG]] antibodies in [[serum]], [[whole blood]], or [[urine]].<ref name="pmid11190069">{{cite journal| author=Ho B, Marshall BJ| title=Accurate diagnosis of Helicobacter pylori. Serologic testing. | journal=Gastroenterol Clin North Am | year= 2000 | volume= 29 | issue= 4 | pages= 853-62 | pmid=11190069 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11190069  }} </ref><ref name="pmid8651160">{{cite journal| author=Loy CT, Irwig LM, Katelaris PH, Talley NJ| title=Do commercial serological kits for Helicobacter pylori infection differ in accuracy? A meta-analysis. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 6 | pages= 1138-44 | pmid=8651160 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8651160  }} </ref><ref name="pmid10364016">{{cite journal| author=Chey WD, Murthy U, Shaw S, Zawadski A, Montague J, Linscheer W et al.| title=A comparison of three fingerstick, whole blood antibody tests for Helicobacter pylori infection: a United States, multicenter trial. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 6 | pages= 1512-6 | pmid=10364016 | doi=10.1111/j.1572-0241.1999.1135_x.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10364016  }} </ref>
*The [[IgG]] antibodies typically become detected 21 days after [[infection]] and can remain present long after eradication.
*The [[IgG]] antibodies typically become detected 21 days after [[infection]] and can remain present long after eradication.
*[[Antibodies]] are detected using [[enzyme-linked immunosorbent assay|enzyme-linked immunosorbent assay (ELISA)]] and [[latex agglutination]] techniques.
*[[Antibodies]] are detected using [[enzyme-linked immunosorbent assay|enzyme-linked immunosorbent assay (ELISA)]] and [[Latex agglutination test|latex agglutination]] techniques.


===Urea Breath Tests===
===Urea Breath Test (UBT)===
*Urea breath test identifies active ''[[H. pylori]]'' infection.<ref name="pmid15569102">{{cite journal| author=Gisbert JP, Pajares JM| title=Review article: 13C-urea breath test in the diagnosis of Helicobacter pylori infection -- a critical review. | journal=Aliment Pharmacol Ther | year= 2004 | volume= 20 | issue= 10 | pages= 1001-17 | pmid=15569102 | doi=10.1111/j.1365-2036.2004.02203.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15569102  }} </ref><ref name="pmid11190074">{{cite journal| author=Chey WD| title=Accurate diagnosis of Helicobacter pylori. 14C-urea breath test. | journal=Gastroenterol Clin North Am | year= 2000 | volume= 29 | issue= 4 | pages= 895-902 | pmid=11190074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11190074  }} </ref>
*[[Urea breath test]] identifies active ''[[H. pylori]]'' infection.<ref name="pmid15569102">{{cite journal| author=Gisbert JP, Pajares JM| title=Review article: 13C-urea breath test in the diagnosis of Helicobacter pylori infection -- a critical review. | journal=Aliment Pharmacol Ther | year= 2004 | volume= 20 | issue= 10 | pages= 1001-17 | pmid=15569102 | doi=10.1111/j.1365-2036.2004.02203.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15569102  }} </ref><ref name="pmid11190074">{{cite journal| author=Chey WD| title=Accurate diagnosis of Helicobacter pylori. 14C-urea breath test. | journal=Gastroenterol Clin North Am | year= 2000 | volume= 29 | issue= 4 | pages= 895-902 | pmid=11190074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11190074  }} </ref>
*'''Procedure'''
*'''Procedure'''
:*The urea labeled with either the nonradioactive isotope 13C or the radioactive isotope 14C is ingested.
:*The [[urea]] labeled with either the nonradioactive isotope <sup>13</sup>C or the radioactive isotope <sup>14</sup>C is ingested.
:*The H.pylori urease converts labeled urea to CO2, which can be quantitated in expired breath.
:*The ''[[H. pylori]]'' [[urease]] converts labeled [[urea]] to [[CO2|CO<sub>2</sub>]], which can be quantitated in expired breath.
*13C labeled urea is preferred in children and pregnant females.
*<sup>13</sup>C labeled [[urea]] is preferred in children and pregnant females.
*The urea breath test has 95% sensitivity and specificity.<ref name="pmid8540496">{{cite journal| author=Steen T, Berstad K, Meling T, Berstad A| title=Reproducibility of the 14C urea breath test repeated after 1 week. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 12 | pages= 2103-5 | pmid=8540496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8540496  }} </ref>
*The [[urea breath test]] has 95% [[sensitivity]] and [[specificity]].<ref name="pmid8540496">{{cite journal| author=Steen T, Berstad K, Meling T, Berstad A| title=Reproducibility of the 14C urea breath test repeated after 1 week. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 12 | pages= 2103-5 | pmid=8540496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8540496  }} </ref>
*This test is an accurate means of post-treatment testing.<ref name="pmid10445534">{{cite journal| author=Leodolter A, Domínguez-Muñoz JE, von Arnim U, Kahl S, Peitz U, Malfertheiner P| title=Validity of a modified 13C-urea breath test for pre- and posttreatment diagnosis of Helicobacter pylori infection in the routine clinical setting. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 8 | pages= 2100-4 | pmid=10445534 | doi=10.1111/j.1572-0241.1999.01284.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10445534  }} </ref><ref name="pmid12425544">{{cite journal| author=Perri F, Manes G, Neri M, Vaira D, Nardone G| title=Helicobacter pylori antigen stool test and 13C-urea breath test in patients after eradication treatments. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 11 | pages= 2756-62 | pmid=12425544 | doi=10.1111/j.1572-0241.2002.07065.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12425544  }} </ref>
*This test is an accurate means of post-treatment testing.<ref name="pmid10445534">{{cite journal| author=Leodolter A, Domínguez-Muñoz JE, von Arnim U, Kahl S, Peitz U, Malfertheiner P| title=Validity of a modified 13C-urea breath test for pre- and posttreatment diagnosis of Helicobacter pylori infection in the routine clinical setting. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 8 | pages= 2100-4 | pmid=10445534 | doi=10.1111/j.1572-0241.1999.01284.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10445534  }} </ref><ref name="pmid12425544">{{cite journal| author=Perri F, Manes G, Neri M, Vaira D, Nardone G| title=Helicobacter pylori antigen stool test and 13C-urea breath test in patients after eradication treatments. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 11 | pages= 2756-62 | pmid=12425544 | doi=10.1111/j.1572-0241.2002.07065.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12425544  }} </ref>
*As this test mainly depends on [[urease]] activity of ''[[H. pylori]], the sensitivity of the test is decreased by medications such as [[bismuth]] containing products, [[proton pump inhibitor|PPIs]], and [[antibiotics]] as they reduce organism density or [[urease]] activity. It is recommended to withhold [[proton pump inhibitor|PPIs]] for 7-14 days prior to the test, and bismuth and antibiotics are withheld for at least 28 days.<ref name="pmid12809820">{{cite journal| author=Graham DY, Opekun AR, Hammoud F, Yamaoka Y, Reddy R, Osato MS et al.| title=Studies regarding the mechanism of false negative urea breath tests with proton pump inhibitors. | journal=Am J Gastroenterol | year= 2003 | volume= 98 | issue= 5 | pages= 1005-9 | pmid=12809820 | doi=10.1111/j.1572-0241.2003.07426.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12809820  }} </ref><ref name="pmid9068466">{{cite journal| author=Chey WD, Woods M, Scheiman JM, Nostrant TT, DelValle J| title=Lansoprazole and ranitidine affect the accuracy of the 14C-urea breath test by a pH-dependent mechanism. | journal=Am J Gastroenterol | year= 1997 | volume= 92 | issue= 3 | pages= 446-50 | pmid=9068466 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9068466  }} </ref><ref name="pmid9758575">{{cite journal| author=Laine L, Estrada R, Trujillo M, Knigge K, Fennerty MB| title=Effect of proton-pump inhibitor therapy on diagnostic testing for Helicobacter pylori. | journal=Ann Intern Med | year= 1998 | volume= 129 | issue= 7 | pages= 547-50 | pmid=9758575 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9758575  }} </ref> ''
*As this test mainly depends on [[urease]] activity of ''[[H. pylori]], ''the [[sensitivity]] of the test is decreased by medications such as [[bismuth]] containing products, [[proton pump inhibitor|PPIs]], and [[antibiotics]] as they reduce organism density or [[urease]] activity. It is recommended to withhold [[proton pump inhibitor|PPIs]] for 7-14 days prior to the test, and bismuth and antibiotics are withheld for at least 28 days.<ref name="pmid12809820">{{cite journal| author=Graham DY, Opekun AR, Hammoud F, Yamaoka Y, Reddy R, Osato MS et al.| title=Studies regarding the mechanism of false negative urea breath tests with proton pump inhibitors. | journal=Am J Gastroenterol | year= 2003 | volume= 98 | issue= 5 | pages= 1005-9 | pmid=12809820 | doi=10.1111/j.1572-0241.2003.07426.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12809820  }} </ref><ref name="pmid9068466">{{cite journal| author=Chey WD, Woods M, Scheiman JM, Nostrant TT, DelValle J| title=Lansoprazole and ranitidine affect the accuracy of the 14C-urea breath test by a pH-dependent mechanism. | journal=Am J Gastroenterol | year= 1997 | volume= 92 | issue= 3 | pages= 446-50 | pmid=9068466 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9068466  }} </ref><ref name="pmid9758575">{{cite journal| author=Laine L, Estrada R, Trujillo M, Knigge K, Fennerty MB| title=Effect of proton-pump inhibitor therapy on diagnostic testing for Helicobacter pylori. | journal=Ann Intern Med | year= 1998 | volume= 129 | issue= 7 | pages= 547-50 | pmid=9758575 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9758575  }} </ref>  
*[[Antacids]] do not affect the efficacy of the test.<ref name="pmid15128344">{{cite journal| author=Gatta L, Vakil N, Ricci C, Osborn JF, Tampieri A, Perna F et al.| title=Effect of proton pump inhibitors and antacid therapy on 13C urea breath tests and stool test for Helicobacter pylori infection. | journal=Am J Gastroenterol | year= 2004 | volume= 99 | issue= 5 | pages= 823-9 | pmid=15128344 | doi=10.1111/j.1572-0241.2004.30162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15128344  }} </ref>
*[[Antacids]] do not affect the efficacy of the test.<ref name="pmid15128344">{{cite journal| author=Gatta L, Vakil N, Ricci C, Osborn JF, Tampieri A, Perna F et al.| title=Effect of proton pump inhibitors and antacid therapy on 13C urea breath tests and stool test for Helicobacter pylori infection. | journal=Am J Gastroenterol | year= 2004 | volume= 99 | issue= 5 | pages= 823-9 | pmid=15128344 | doi=10.1111/j.1572-0241.2004.30162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15128344  }} </ref>


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*The [[fecal antigen test|fecal antigen test (FAT)]] is an [[enzyme immunoassay]] which identifies ''[[H. pylori]]'' antigen with the use of [[polyclonal]] anti-H.pylori antibody.<ref name="pmid15270750">{{cite journal| author=Gisbert JP, Pajares JM| title=Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review. | journal=Helicobacter | year= 2004 | volume= 9 | issue= 4 | pages= 347-68 | pmid=15270750 | doi=10.1111/j.1083-4389.2004.00235.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270750  }} </ref><ref name="pmid16780557">{{cite journal| author=Gisbert JP, de la Morena F, Abraira V| title=Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. | journal=Am J Gastroenterol | year= 2006 | volume= 101 | issue= 8 | pages= 1921-30 | pmid=16780557 | doi=10.1111/j.1572-0241.2006.00668.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16780557  }} </ref>
*The [[fecal antigen test|fecal antigen test (FAT)]] is an [[enzyme immunoassay]] which identifies ''[[H. pylori]]'' antigen with the use of [[polyclonal]] anti-H.pylori antibody.<ref name="pmid15270750">{{cite journal| author=Gisbert JP, Pajares JM| title=Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review. | journal=Helicobacter | year= 2004 | volume= 9 | issue= 4 | pages= 347-68 | pmid=15270750 | doi=10.1111/j.1083-4389.2004.00235.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270750  }} </ref><ref name="pmid16780557">{{cite journal| author=Gisbert JP, de la Morena F, Abraira V| title=Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. | journal=Am J Gastroenterol | year= 2006 | volume= 101 | issue= 8 | pages= 1921-30 | pmid=16780557 | doi=10.1111/j.1572-0241.2006.00668.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16780557  }} </ref>
*[[Monoclonal antibodies]] can also be used to identify fecal ''[[H. pylori]]'' antigens.
*[[Monoclonal antibodies]] can also be used to identify fecal ''[[H. pylori]]'' antigens.
*Both tests are used to screen for infection and post-treatment testing.
*Both tests are used to screen for [[infection]] and post-treatment testing.
*The fecal antigen test is approved by U.S Food and Drug Administration as an alternative means of establishing ''[[H. pylori]]'' cure to urea breath test.
*The fecal antigen test is approved by [[Food and Drug Administration|U.S Food and Drug Administration]] as an alternative means of establishing ''[[H. pylori]]'' cure to [[urea breath test]].
*The polyclonal test has excellent sensitivity, specificity, and predictive values before treatment but less satisfactory after the treatment.
*The polyclonal test has excellent [[sensitivity]], [[specificity]], and predictive values before treatment but less satisfactory after the treatment.
*This test may be effective in confirming eradication of ''[[H. pylori]]'' infection as early as 14 days after treatment. However, it is suggested that it should be done more than 4 wk and up to 8-12 wk after ''[[H. pylori]]'' treatment.<ref name="pmid11848725">{{cite journal| author=Vaira D, Vakil N, Menegatti M, van't Hoff B, Ricci C, Gatta L et al.| title=The stool antigen test for detection of Helicobacter pylori after eradication therapy. | journal=Ann Intern Med | year= 2002 | volume= 136 | issue= 4 | pages= 280-7 | pmid=11848725 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11848725  }} </ref><ref name="pmid15270750">{{cite journal| author=Gisbert JP, Pajares JM| title=Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review. | journal=Helicobacter | year= 2004 | volume= 9 | issue= 4 | pages= 347-68 | pmid=15270750 | doi=10.1111/j.1083-4389.2004.00235.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270750  }} </ref>
*This test may be effective in confirming eradication of ''[[H. pylori]]'' infection as early as 14 days after treatment. However, it is suggested that it should be done more than 4 wk and up to 8-12 wk after ''[[H. pylori]]'' treatment.<ref name="pmid11848725">{{cite journal| author=Vaira D, Vakil N, Menegatti M, van't Hoff B, Ricci C, Gatta L et al.| title=The stool antigen test for detection of Helicobacter pylori after eradication therapy. | journal=Ann Intern Med | year= 2002 | volume= 136 | issue= 4 | pages= 280-7 | pmid=11848725 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11848725  }} </ref><ref name="pmid15270750">{{cite journal| author=Gisbert JP, Pajares JM| title=Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review. | journal=Helicobacter | year= 2004 | volume= 9 | issue= 4 | pages= 347-68 | pmid=15270750 | doi=10.1111/j.1083-4389.2004.00235.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15270750  }} </ref>
*The sensitivity of the test is affected by the use of [[proton pump inhibitors|PPIs]], [[bismuth|bismuth compounds]], and [[antibiotics]]. The specificity is affected by the bleeding [[peptic ulcer disease]].<ref name="pmid11922552">{{cite journal| author=Odaka T, Yamaguchi T, Koyama H, Saisho H, Nomura F| title=Evaluation of the Helicobacter pylori stool antigen test for monitoring eradication therapy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 3 | pages= 594-9 | pmid=11922552 | doi=10.1111/j.1572-0241.2002.05535.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11922552  }} </ref>
*The [[sensitivity]] of the test is affected by the use of [[proton pump inhibitors|PPIs]], [[bismuth|bismuth compounds]], and [[antibiotics]]. The [[specificity]] is affected by the bleeding [[peptic ulcer disease]].<ref name="pmid11922552">{{cite journal| author=Odaka T, Yamaguchi T, Koyama H, Saisho H, Nomura F| title=Evaluation of the Helicobacter pylori stool antigen test for monitoring eradication therapy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 3 | pages= 594-9 | pmid=11922552 | doi=10.1111/j.1572-0241.2002.05535.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11922552  }} </ref>


{| class="wikitable"
{| class="wikitable"
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! style="background:#4479BA; color: #FFFFFF;" + | Disadvantages
! style="background:#4479BA; color: #FFFFFF;" + | Disadvantages
|-
|-
| style="background:#DCDCDC; + " | 1. [[ELISA]] serology
| style="background:#DCDCDC; + " | '''1. [[ELISA]] serology'''
(quantitative and qualitative)
'''(quantitative and qualitative)'''
|
|
* Inexpensive and widely available
* Inexpensive and widely available
* Very good NPV
* Very good [[negative predictive value]] (NPV)
* Sensitivity (85-92%) and specificity (70-83%)
* [[Sensitivity]] (85-92%) and [[specificity]] (70-83%)
|
|
* PPV dependent upon background ''[[H. pylori]]'' prevalence.  
* PPV dependent upon background [[H. pylori|''H. pylori'']] prevalence.  
* ''Not recommended after ''[[H. pylori]]'' therapy''
* Not recommended after [[H. pylori|''H. pylori'']] therapy
* Less accurate and does not identify infection
* Less accurate and does not identify [[infection]]
|-
|-
| style="background:#DCDCDC; + " | *2. Urea breath tests (13C and 14C)
| style="background:#DCDCDC; + " | '''2. Urea breath tests (13C and 14C)'''
|
|
* Identifies active ''[[H. pylori]]'' infection.
* Identifies active ''[[H. pylori]]'' infection
* Excellent PPV and NPV regardless of ''[[H. pylori]]'' prevalence.
* Excellent PPV and NPV regardless of ''[[H. pylori]]'' prevalence  
* Useful before and after ''[[H. pylori]]'' therapy
* Useful before and after ''[[H. pylori]]'' therapy
* Sensitivity (95%) and specificity (96%)
* [[Sensitivity]] (95%) and [[specificity]] (96%)
|
|
* Reimbursement and availability remain inconsistent
* Reimbursement and availability remain inconsistent
|-
|-
| style="background:#DCDCDC; + " | *3. Fecal antigen test
| style="background:#DCDCDC; + " | '''3. Fecal antigen test'''
|
|
* Identifies active ''[[H. pylori]]'' infection.  
* Identifies active ''[[H. pylori]]'' infection.  
* Excellent positive and negative predictive values regardless of ''[[H. pylori]]'' prevalence.
* Excellent PPV and NPV regardless of ''[[H. pylori]]'' prevalence  
* Useful before and after ''[[H. pylori]]'' therapy
* Useful before and after ''[[H. pylori]]'' therapy
* Sensitivity (95%) and specificity (94%)
* [[Sensitivity]] (95%) and [[specificity]] (94%)
|
|
* Polyclonal test less well validated than the UBT in the post treatment setting.
* Polyclonal test less well validated than the UBT in the post-treatment setting  


* The monoclonal test appears reliable before and after [[antibiotic]] therapy.
* The monoclonal test appears reliable before and after [[antibiotic]] therapy  
* Unpleasantness associated with collecting stool
* Unpleasantness associated with collecting stool
|}
|}
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]

Latest revision as of 21:49, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

The non-endoscopic diagnostic testing methods for gastritis associated with H. pylori include antibody tests, urea breath test, and fecal antigen test.

Non-endoscopic diagnostic studies

The non-endoscopic diagnostic testing methods for H. pylori include:

  • The UBT and fecal antigen tests provide reliable means of identifying active H. pylori infection before antibiotic therapy.
  • The UBT is the most reliable non endoscopic test to document eradication of H. pylori infection.
  • The monoclonal fecal antigen test provides another non-endoscopic means of establishing H. pylori cure after antibiotic treatment.
  • Testing to prove H. pylori eradication appears to be most accurate if performed at least 4 wk after the completion of antibiotic therapy.

Antibody tests

Urea Breath Test (UBT)

  • The urea labeled with either the nonradioactive isotope 13C or the radioactive isotope 14C is ingested.
  • The H. pylori urease converts labeled urea to CO2, which can be quantitated in expired breath.

Fecal Antigen Test (FAT)

Nonendoscopic testing Advantages Disadvantages
1. ELISA serology

(quantitative and qualitative)

  • PPV dependent upon background H. pylori prevalence.
  • Not recommended after H. pylori therapy
  • Less accurate and does not identify infection
2. Urea breath tests (13C and 14C)
  • Reimbursement and availability remain inconsistent
3. Fecal antigen test
  • Polyclonal test less well validated than the UBT in the post-treatment setting
  • The monoclonal test appears reliable before and after antibiotic therapy
  • Unpleasantness associated with collecting stool

References

  1. ↑ Ho B, Marshall BJ (2000). "Accurate diagnosis of Helicobacter pylori. Serologic testing". Gastroenterol Clin North Am. 29 (4): 853–62. PMID 11190069.
  2. ↑ Loy CT, Irwig LM, Katelaris PH, Talley NJ (1996). "Do commercial serological kits for Helicobacter pylori infection differ in accuracy? A meta-analysis". Am J Gastroenterol. 91 (6): 1138–44. PMID 8651160.
  3. ↑ Chey WD, Murthy U, Shaw S, Zawadski A, Montague J, Linscheer W; et al. (1999). "A comparison of three fingerstick, whole blood antibody tests for Helicobacter pylori infection: a United States, multicenter trial". Am J Gastroenterol. 94 (6): 1512–6. doi:10.1111/j.1572-0241.1999.1135_x.x. PMID 10364016.
  4. ↑ Gisbert JP, Pajares JM (2004). "Review article: 13C-urea breath test in the diagnosis of Helicobacter pylori infection -- a critical review". Aliment Pharmacol Ther. 20 (10): 1001–17. doi:10.1111/j.1365-2036.2004.02203.x. PMID 15569102.
  5. ↑ Chey WD (2000). "Accurate diagnosis of Helicobacter pylori. 14C-urea breath test". Gastroenterol Clin North Am. 29 (4): 895–902. PMID 11190074.
  6. ↑ Steen T, Berstad K, Meling T, Berstad A (1995). "Reproducibility of the 14C urea breath test repeated after 1 week". Am J Gastroenterol. 90 (12): 2103–5. PMID 8540496.
  7. ↑ Leodolter A, Domínguez-Muñoz JE, von Arnim U, Kahl S, Peitz U, Malfertheiner P (1999). "Validity of a modified 13C-urea breath test for pre- and posttreatment diagnosis of Helicobacter pylori infection in the routine clinical setting". Am J Gastroenterol. 94 (8): 2100–4. doi:10.1111/j.1572-0241.1999.01284.x. PMID 10445534.
  8. ↑ Perri F, Manes G, Neri M, Vaira D, Nardone G (2002). "Helicobacter pylori antigen stool test and 13C-urea breath test in patients after eradication treatments". Am J Gastroenterol. 97 (11): 2756–62. doi:10.1111/j.1572-0241.2002.07065.x. PMID 12425544.
  9. ↑ Graham DY, Opekun AR, Hammoud F, Yamaoka Y, Reddy R, Osato MS; et al. (2003). "Studies regarding the mechanism of false negative urea breath tests with proton pump inhibitors". Am J Gastroenterol. 98 (5): 1005–9. doi:10.1111/j.1572-0241.2003.07426.x. PMID 12809820.
  10. ↑ Chey WD, Woods M, Scheiman JM, Nostrant TT, DelValle J (1997). "Lansoprazole and ranitidine affect the accuracy of the 14C-urea breath test by a pH-dependent mechanism". Am J Gastroenterol. 92 (3): 446–50. PMID 9068466.
  11. ↑ Laine L, Estrada R, Trujillo M, Knigge K, Fennerty MB (1998). "Effect of proton-pump inhibitor therapy on diagnostic testing for Helicobacter pylori". Ann Intern Med. 129 (7): 547–50. PMID 9758575.
  12. ↑ Gatta L, Vakil N, Ricci C, Osborn JF, Tampieri A, Perna F; et al. (2004). "Effect of proton pump inhibitors and antacid therapy on 13C urea breath tests and stool test for Helicobacter pylori infection". Am J Gastroenterol. 99 (5): 823–9. doi:10.1111/j.1572-0241.2004.30162.x. PMID 15128344.
  13. ↑ 13.0 13.1 Gisbert JP, Pajares JM (2004). "Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review". Helicobacter. 9 (4): 347–68. doi:10.1111/j.1083-4389.2004.00235.x. PMID 15270750.
  14. ↑ Gisbert JP, de la Morena F, Abraira V (2006). "Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis". Am J Gastroenterol. 101 (8): 1921–30. doi:10.1111/j.1572-0241.2006.00668.x. PMID 16780557.
  15. ↑ Vaira D, Vakil N, Menegatti M, van't Hoff B, Ricci C, Gatta L; et al. (2002). "The stool antigen test for detection of Helicobacter pylori after eradication therapy". Ann Intern Med. 136 (4): 280–7. PMID 11848725.
  16. ↑ 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.

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