II. Indications

  1. Dyspepsia evaluation

III. Labs: First-Line Helicobacter Pylori tests

  1. Urea Breath Test
    1. Test Sensitivity: 97%
    2. Test Specificity: 100%
    3. Requires Fasting for 6 hours, no PPI for 2 weeks before test, and expensive
  2. Stool monoclonal antigen tests (enzyme immunoassay)
    1. Test Sensitivity: 92%
    2. Test Specificity: 94%
    3. Most accurate, but more expensive than immunochromatography
  3. Stool monoclonal antigen tests (Immunochromatography)
    1. Test Sensitivity: 69-87%
    2. Test Specificity: 87-93%
    3. Variable reliability, but available for office based testing

IV. Labs: Other Helicobacter PyloriAntibody or Antigen testing

  1. IgG testing may be positive for years after eradication
    1. Indicated only for initial diagnosis
    2. Not used to confirm H. pylori cure
  2. Reference lab serology (ELISA for H. pylori IgG)
    1. Test Sensitivity: 90-93%
    2. Test Specificity: 95-96%
  3. Office-based lab whole blood serology (ELISA for IgG)
    1. Test Sensitivity: 50-85%
    2. Test Specificity: 75-100%
  4. Urine ELISA for H. pylori IgG
    1. Test Sensitivity: 70-96%
    2. Test Specificity: 77-85%
  5. Saliva ELISA for H. pylori IgG
    1. Test Sensitivity: 82-91%
    2. Test Specificity: 71-85%

V. Other Testing: String Test

  1. Mechanism
    1. Polymer string is swallowed
    2. String is recovered and run for PCR or culture
  2. Accuracy
    1. Test Sensitivity: 75-80%
    2. Test Specificity: 75-100%

VI. Advantages

  1. Noninvasive procedure

VII. Disadvantages

  1. Tests do not confirm cure after H. pylori management
  2. Cure confirmation is only by the following tests
    1. Urea Breath Test
    2. H. pylori Stool Antigen (HpSA)
    3. Endoscopic Biopsy for H. pylori

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