Helicobacter pylori: Overview and Considerations for Diagnostic Testing
In 2007, the American College of Gastroenterology updated its guidelines for the diagnosis and management of Helicobacter pylori infections. Because of the proven linkage between Helicobacter pylori infection and peptic ulcer disease, these guidelines defined indications for diagnostic testing in patients with:
- Active peptic ulcer disease
- A past history of documented peptic ulcer
- Gastric mucosa associated lymphoid tissue, or MALT lymphoma, a history of gastric cancer, or a relative with gastric cancer
However, it should be said that in the presence of outright alarm features; GI bleeding, anemia, weight loss, persistent vomiting, the patient should proceed directly to endoscopy with accompanying histological studies. Testing for Helicobacter pylori and treatment of positives is an approved approach due to increased healthcare costs; approximately 6 billion dollars a year, and loss of productivity in individuals with peptic ulcer disease and Helicobacter pylori infection. For dyspeptic patients <45 years old, a noninvasive Helicobacter pylori test, and treatment, if positive, is recommended.
Although we will not extensively discuss treatment during this presentation, a regimen of a proton pump inhibitor, clarithromycin, amoxicillin, or metronidazole for 14 days is generally indicated. Bismuth may also be added to increase efficacy of the treatment regimen.
Diagnosis of Infection
Jump to section:
- Helicobacter pylori
- Helicobacter spp. History1
- Diagnosis of Infection
- Types of Testing
- Rapid Urease Test
- Types of Testing
- Urea Breath Test
- Urea Breath Test Limitations
- Serology - IgM and IgA ELISA3
- Serology: IgG ELFA
- Serology Limitations
- Fecal Antigen Test EIA
- "Test of Cure"
- Tests Available From Mayo Medical Laboratories