Helicobacter pylori: Difference between revisions
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==Diagnosis== | |||
===Prior infection=== | |||
Detection of serum [[antibody|antibodies]] against [[H. pylori]] indicate prior infection. The probability of having positive antibody test is approximately the same as the age of the patient.<ref name="pmid2179722">{{cite journal |author=Soll AH |title=Pathogenesis of peptic ulcer and implications for therapy |journal=N. Engl. J. Med. |volume=322 |issue=13 |pages=909–16 |year=1990 |pmid=2179722 |doi=}}</ref> For example, a 50 year old male has approximately a 50% chance of having antibodies against ''H. pylori''. | |||
===Active infection=== | |||
There is no one test that detects all patients infected with ''H. pylori''. | |||
====Non-invasive tests==== | |||
[[Clinical practice guideline]]s by the American Gastroenterological Association state "''[[H. pylori]]'' testing is optimally performed by a <sup>13</sup>C-urea breath test or stool antigen test."<ref name="pmid16285970">{{cite journal |author=Talley NJ |title=American Gastroenterological Association medical position statement: evaluation of dyspepsia |journal=Gastroenterology |volume=129 |issue=5 |pages=1753–5 |year=2005 |pmid=16285970 |doi=10.1053/j.gastro.2005.09.019}} [http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=8442&nbr=004711 National Guideline Clearinghouse]</ref> | |||
====Invasive tests==== | |||
''[[H. pylori]]'' can be detected during esophagogastroduodenoscopy (EGD) by biopsy, culture, or rapid urease testing. | |||
==Treatment== | ==Treatment== | ||
Clinical practice guidelines by the American College of Gastroenterology guide treat.<ref name="pmid17608775">{{cite journal |author=Chey WD, Wong BC |title=American College of Gastroenterology guideline on the management of Helicobacter pylori infection |journal=Am. J. Gastroenterol. |volume=102 |issue=8 |pages=1808–25 |year=2007 |pmid=17608775 |doi=10.1111/j.1572-0241.2007.01393.x}}</ref> | Clinical practice guidelines by the American College of Gastroenterology guide treat.<ref name="pmid17608775">{{cite journal |author=Chey WD, Wong BC |title=American College of Gastroenterology guideline on the management of Helicobacter pylori infection |journal=Am. J. Gastroenterol. |volume=102 |issue=8 |pages=1808–25 |year=2007 |pmid=17608775 |doi=10.1111/j.1572-0241.2007.01393.x}}</ref> | ||
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* "Testing to prove eradication should be performed in patients who receive treatment of ''H. pylori'' for peptic ulcer disease, individuals with persistent dyspeptic symptoms despite the test-and-treat strategy, those with ''H. pylori''-associated MALT lymphoma, and individuals who have undergone resection of early gastric cancer". | * "Testing to prove eradication should be performed in patients who receive treatment of ''H. pylori'' for peptic ulcer disease, individuals with persistent dyspeptic symptoms despite the test-and-treat strategy, those with ''H. pylori''-associated MALT lymphoma, and individuals who have undergone resection of early gastric cancer". | ||
* "For patients with persistent ''H. pylori'' consider bismuth quadruple therapy. A PPI, levofloxacin, and amoxicillin for 10 days is more effective and better tolerated than bismuth quadruple therapy for persistent ''H. pylori''". | * "For patients with persistent ''H. pylori'' consider bismuth quadruple therapy. A PPI, levofloxacin, and amoxicillin for 10 days is more effective and better tolerated than bismuth quadruple therapy for persistent ''H. pylori''". | ||
==History== | |||
Barry Marshall and Robin Warren won the 2005 Nobel Prize in Physiology or Medicine for discovery of '''''Helicobacter pylori''''' in 1983.<ref name="pmid16339090">{{cite journal |author=Parsonnet J |title=Clinician-discoverers--Marshall, Warren, and H. pylori |journal=N. Engl. J. Med. |volume=353 |issue=23 |pages=2421–3 |year=2005 |pmid=16339090 |doi=10.1056/NEJMp058270}}</ref><ref name="pmid6145023">{{cite journal |author=Marshall BJ, Warren JR |title=Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration |journal=Lancet |volume=1 |issue=8390 |pages=1311–5 |year=1984 |pmid=6145023 |doi=}}</ref> | |||
==References== | ==References== | ||
Revision as of 00:33, 12 October 2007
Diagnosis
Prior infection
Detection of serum antibodies against H. pylori indicate prior infection. The probability of having positive antibody test is approximately the same as the age of the patient.[1] For example, a 50 year old male has approximately a 50% chance of having antibodies against H. pylori.
Active infection
There is no one test that detects all patients infected with H. pylori.
Non-invasive tests
Clinical practice guidelines by the American Gastroenterological Association state "H. pylori testing is optimally performed by a 13C-urea breath test or stool antigen test."[2]
Invasive tests
H. pylori can be detected during esophagogastroduodenoscopy (EGD) by biopsy, culture, or rapid urease testing.
Treatment
Clinical practice guidelines by the American College of Gastroenterology guide treat.[3] Regarding which patient to treat:
- "Testing is uncertain among patients with functional dyspepsia, gastroesophageal reflux disease (GERD), patients taking nonsteroidal antiinflammatory drugs, with iron deficiency anemia, or who are at risk of developing gastric cancer".
Regarding how to treat:
- "Eradication rates achieved by first-line treatment with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin have decreased to 70-85%, in part due to increasing clarithromycin resistance".
- "Eradication rates may also be lower with 7 versus 14-day regimens."
Regarding follow-up of treatment:
- "Testing to prove eradication should be performed in patients who receive treatment of H. pylori for peptic ulcer disease, individuals with persistent dyspeptic symptoms despite the test-and-treat strategy, those with H. pylori-associated MALT lymphoma, and individuals who have undergone resection of early gastric cancer".
- "For patients with persistent H. pylori consider bismuth quadruple therapy. A PPI, levofloxacin, and amoxicillin for 10 days is more effective and better tolerated than bismuth quadruple therapy for persistent H. pylori".
History
Barry Marshall and Robin Warren won the 2005 Nobel Prize in Physiology or Medicine for discovery of Helicobacter pylori in 1983.[4][5]
References
- ↑ Soll AH (1990). "Pathogenesis of peptic ulcer and implications for therapy". N. Engl. J. Med. 322 (13): 909–16. PMID 2179722. [e]
- ↑ Talley NJ (2005). "American Gastroenterological Association medical position statement: evaluation of dyspepsia". Gastroenterology 129 (5): 1753–5. DOI:10.1053/j.gastro.2005.09.019. PMID 16285970. Research Blogging. National Guideline Clearinghouse
- ↑ Chey WD, Wong BC (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. Research Blogging.
- ↑ Parsonnet J (2005). "Clinician-discoverers--Marshall, Warren, and H. pylori". N. Engl. J. Med. 353 (23): 2421–3. DOI:10.1056/NEJMp058270. PMID 16339090. Research Blogging.
- ↑ Marshall BJ, Warren JR (1984). "Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration". Lancet 1 (8390): 1311–5. PMID 6145023. [e]