Dyspepsia laboratory findings: Difference between revisions
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{{Dyspepsia}} | {{Dyspepsia}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Ajay}} | ||
==Overview== | ==Overview== | ||
There is no specific diagnostic laboratory test for dyspepsia but in the patient with the history of dyspepsia, the laboratory test is used to rule out [[peptic ulcer]] [[bleeding]] and to document the status of eradication therapy (in terms of treatment failure or success), and to test refractory [[ulcers]]. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
*People under the age of 55 years with no alarm features do not need EGD but are considered for investigation for peptic ulcer disease caused by ''[[Helicobacter pylori]]'' [[infection]]. | *People under the age of 55 years with no alarm features do not need [[esophagogastroduodenoscopy]] ([[EGD]]) but are considered for investigation for [[peptic ulcer disease]] caused by ''[[Helicobacter pylori]]'' [[infection]]. | ||
*Investigation for ''H.pylori'' infection is usually performed when there is a moderate to high prevalence of this infection in the local community or the person with dyspepsia has other risk factors for ''H. pylori'' infection, related for example to ethnicity or | *Investigation for ''[[Helicobacter Pylori|H.pylori]]'' [[infection]] is usually performed when there is a moderate to high [[prevalence]] of this [[infection]] in the local community or the person with dyspepsia has other [[risk factors]] for ''[[H. pylori]]'' [[infection]], related for example to ethnicity or emigration from a high-[[prevalence]] area. | ||
*If the infection is confirmed it can usually be eradicated by medication. | *If the [[infection]] is confirmed it can usually be eradicated by medication. | ||
==Initial Laboratory Studies== | |||
*There are no abnormal laboratory findings associated with dyspepsia. | |||
*If there is the history of dyspepsia then following laboratory test are done:<ref name="pmid10086037">{{cite journal |vauthors=Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE |title=Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis |journal=Postgrad Med |volume=105 |issue=3 |pages=113–6, 121–3, 127–8 passim |year=1999 |pmid=10086037 |doi=10.3810/pgm.1999.03.594 |url=}}</ref><ref name="pmid2216988">{{cite journal |vauthors=Rosen SD, Rogers AI |title=Clinical recognition and evaluation of peptic ulcer disease |journal=Postgrad Med |volume=88 |issue=5 |pages=42–7,51,55 |year=1990 |pmid=2216988 |doi= |url=}}</ref><ref name="pmid25955624">{{cite journal |vauthors=Fashner J, Gitu AC |title=Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection |journal=Am Fam Physician |volume=91 |issue=4 |pages=236–42 |year=2015 |pmid=25955624 |doi= |url=}}</ref><ref name="pmid100860372">{{cite journal |vauthors=Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE |title=Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis |journal=Postgrad Med |volume=105 |issue=3 |pages=113–6, 121–3, 127–8 passim |year=1999 |pmid=10086037 |doi=10.3810/pgm.1999.03.594 |url=}}</ref><ref name="pmid26354049">{{cite journal |vauthors=Chung CS, Chiang TH, Lee YC |title=A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers |journal=Korean J. Intern. Med. |volume=30 |issue=5 |pages=559–70 |year=2015 |pmid=26354049 |pmc=4578017 |doi=10.3904/kjim.2015.30.5.559 |url=}}</ref><ref name="pmid21263414">{{cite journal |vauthors=Mehmedović-Redzepović A, Mesihović R, Prnjavorac B, Kulo A, Merlina K |title=Hematologic and laboratory parameters in patientis with peptic ulcer bleeding treated by two modalities of endoscopic haemostasis and proton pump inhibitors |journal=Med Glas (Zenica) |volume=8 |issue=1 |pages=151–7 |year=2011 |pmid=21263414 |doi= |url=}}</ref> | |||
**[[Complete blood count]] | |||
**[[Liver function tests]] | |||
**Serum [[lipase]] and [[amylase]] | |||
**[[Iron]] studies | |||
**Some patients with dyspepsia may have reduced serum [[ferritin]], which is usually suggestive of [[bleeding]] which requires further [[endoscopy]] to rule out [[bleeding]] | |||
'''Patient with a family history of peptic ulcer or there is history of refractory ulcer to treatment''' : | |||
*A fasting serum [[gastrin]] level can be done to screen for [[Zollinger-Ellison syndrome]] | |||
*If the diagnosis of Zollinger-Ellison syndrome cannot be made on the basis of the serum gastrin level, then next step is to do the [[secretin]] stimulation test | |||
'''Following test can be done to document the residual infection after eradication therapy''':<ref name="pmid23551920">{{cite journal |vauthors=Korkmaz H, Kesli R, Karabagli P, Terzi Y |title=Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection |journal=Helicobacter |volume=18 |issue=5 |pages=384–91 |year=2013 |pmid=23551920 |doi=10.1111/hel.12053 |url=}}</ref><ref name="pmid11922552">{{cite journal |vauthors=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. |volume=97 |issue=3 |pages=594–9 |year=2002 |pmid=11922552 |doi=10.1111/j.1572-0241.2002.05535.x |url=}}</ref><ref name="pmid21264478">{{cite journal |vauthors=Shimoyama T, Sawaya M, Ishiguro A, Hanabata N, Yoshimura T, Fukuda S |title=Applicability of a rapid stool antigen test, using monoclonal antibody to catalase, for the management of Helicobacter pylori infection |journal=J. Gastroenterol. |volume=46 |issue=4 |pages=487–91 |year=2011 |pmid=21264478 |doi=10.1007/s00535-011-0371-4 |url=}}</ref><ref name="pmid16091438">{{cite journal |vauthors=Erzin Y, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, Kocazeybek B |title=Evaluation of two enzyme immunoassays for detecting Helicobacter pylori in stool specimens of dyspeptic patients after eradication therapy |journal=J. Med. Microbiol. |volume=54 |issue=Pt 9 |pages=863–6 |year=2005 |pmid=16091438 |doi=10.1099/jmm.0.45914-0 |url=}}</ref><ref name="pmid15545164">{{cite journal |vauthors=Asfeldt AM, Løchen ML, Straume B, Steigen SE, Florholmen J, Goll R, Nestegard O, Paulssen EJ |title=Accuracy of a monoclonal antibody-based stool antigen test in the diagnosis of Helicobacter pylori infection |journal=Scand. J. Gastroenterol. |volume=39 |issue=11 |pages=1073–7 |year=2004 |pmid=15545164 |doi=10.1080/00365520410007944 |url=}}</ref> | |||
*[[Urea breath test]] (carbon 13) tests: This is used to document eradication therapy and should be performed four to six weeks after completion of eradication therapy | |||
**[[Urea breath test]] require the ingestion of [[urea]] labeled with the nonradioactive isotope carbon 13 or carbon 14 | |||
**[[Proton pump inhibitor|Proton pump inhibitors]] ([[Proton pump inhibitor|PPIs]]) should be stopped for two weeks before the test | |||
*Stool monoclonal antigen tests-This detect active [[infection]] and can be used as a test of cure | |||
**[[Proton pump inhibitor|PPIs]] should be stopped for two weeks before testing | |||
**This can be done by following methods: | |||
***[[Enzyme immunoassay]] | |||
***Immunochromatography | |||
***[[Antibody tests]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
Latest revision as of 21:30, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
There is no specific diagnostic laboratory test for dyspepsia but in the patient with the history of dyspepsia, the laboratory test is used to rule out peptic ulcer bleeding and to document the status of eradication therapy (in terms of treatment failure or success), and to test refractory ulcers.
Laboratory Findings
- People under the age of 55 years with no alarm features do not need esophagogastroduodenoscopy (EGD) but are considered for investigation for peptic ulcer disease caused by Helicobacter pylori infection.
- Investigation for H.pylori infection is usually performed when there is a moderate to high prevalence of this infection in the local community or the person with dyspepsia has other risk factors for H. pylori infection, related for example to ethnicity or emigration from a high-prevalence area.
- If the infection is confirmed it can usually be eradicated by medication.
Initial Laboratory Studies
- There are no abnormal laboratory findings associated with dyspepsia.
- If there is the history of dyspepsia then following laboratory test are done:[1][2][3][4][5][6]
- Complete blood count
- Liver function tests
- Serum lipase and amylase
- Iron studies
- Some patients with dyspepsia may have reduced serum ferritin, which is usually suggestive of bleeding which requires further endoscopy to rule out bleeding
Patient with a family history of peptic ulcer or there is history of refractory ulcer to treatment :
- A fasting serum gastrin level can be done to screen for Zollinger-Ellison syndrome
- If the diagnosis of Zollinger-Ellison syndrome cannot be made on the basis of the serum gastrin level, then next step is to do the secretin stimulation test
Following test can be done to document the residual infection after eradication therapy:[7][8][9][10][11]
- Urea breath test (carbon 13) tests: This is used to document eradication therapy and should be performed four to six weeks after completion of eradication therapy
- Urea breath test require the ingestion of urea labeled with the nonradioactive isotope carbon 13 or carbon 14
- Proton pump inhibitors (PPIs) should be stopped for two weeks before the test
- Stool monoclonal antigen tests-This detect active infection and can be used as a test of cure
- PPIs should be stopped for two weeks before testing
- This can be done by following methods:
- Enzyme immunoassay
- Immunochromatography
- Antibody tests
References
- ↑ Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE (1999). "Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis". Postgrad Med. 105 (3): 113–6, 121–3, 127–8 passim. doi:10.3810/pgm.1999.03.594. PMID 10086037.
- ↑ Rosen SD, Rogers AI (1990). "Clinical recognition and evaluation of peptic ulcer disease". Postgrad Med. 88 (5): 42–7, 51, 55. PMID 2216988.
- ↑ Fashner J, Gitu AC (2015). "Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection". Am Fam Physician. 91 (4): 236–42. PMID 25955624.
- ↑ Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE (1999). "Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis". Postgrad Med. 105 (3): 113–6, 121–3, 127–8 passim. doi:10.3810/pgm.1999.03.594. PMID 10086037.
- ↑ Chung CS, Chiang TH, Lee YC (2015). "A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers". Korean J. Intern. Med. 30 (5): 559–70. doi:10.3904/kjim.2015.30.5.559. PMC 4578017. PMID 26354049.
- ↑ Mehmedović-Redzepović A, Mesihović R, Prnjavorac B, Kulo A, Merlina K (2011). "Hematologic and laboratory parameters in patientis with peptic ulcer bleeding treated by two modalities of endoscopic haemostasis and proton pump inhibitors". Med Glas (Zenica). 8 (1): 151–7. PMID 21263414.
- ↑ Korkmaz H, Kesli R, Karabagli P, Terzi Y (2013). "Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection". Helicobacter. 18 (5): 384–91. doi:10.1111/hel.12053. PMID 23551920.
- ↑ 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.
- ↑ Shimoyama T, Sawaya M, Ishiguro A, Hanabata N, Yoshimura T, Fukuda S (2011). "Applicability of a rapid stool antigen test, using monoclonal antibody to catalase, for the management of Helicobacter pylori infection". J. Gastroenterol. 46 (4): 487–91. doi:10.1007/s00535-011-0371-4. PMID 21264478.
- ↑ Erzin Y, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, Kocazeybek B (2005). "Evaluation of two enzyme immunoassays for detecting Helicobacter pylori in stool specimens of dyspeptic patients after eradication therapy". J. Med. Microbiol. 54 (Pt 9): 863–6. doi:10.1099/jmm.0.45914-0. PMID 16091438.
- ↑ Asfeldt AM, Løchen ML, Straume B, Steigen SE, Florholmen J, Goll R, Nestegard O, Paulssen EJ (2004). "Accuracy of a monoclonal antibody-based stool antigen test in the diagnosis of Helicobacter pylori infection". Scand. J. Gastroenterol. 39 (11): 1073–7. doi:10.1080/00365520410007944. PMID 15545164.