Gastritis diagnostic test

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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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