Peptic ulcer laboratory tests
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Peptic ulcer Microchapters |
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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.
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.
| 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.[4]
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.
- ↑ 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.
- ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.