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DIAGNOSIS OF HELICOBACTER PYLORI
It is very important that prior to any testing (except the blood test) for H.pylori
, you have not takenany antibiotics or Pepto Bismol for one month, Losec for one week, or Pepsid, Zantac, Axid, orTagamet for 24 hours before the tests are done.
To decide which is the best treatment for H.pylori
, it may be necessary to do an endoscopy andtake a biopsy (a small piece of tissue) from the lining of the stomach. This allows your doctor togrow your H.pylori
in the laboratory and decide which antibiotic to use.
The Breath Test
A diagram showing how breath tests work is shown below. The figure represents a C14-ureabreath test. In the C13-urea breath test the breath sample is measured in a mass spectrometerrather than a scintillation counter.
Carbon-14-urea Breath Test
In the C14-urea breath test you fast for about 6 hours (from midnight). The test is usuallyperformed in the morning. You swallow a capsule or drink water which contains one microCurie ofC14-urea. You provide the breath sample usually by blowing up a small balloon or blowing bubblesin a small bottle of collection liquid. Samples of breath are then taken between 10 and 20 minutesafter the capsule is given (the exact details may vary from place to place). The C14-urea contains atiny amount of radioactive material which passes out of your body in a day or so in the urine andbreath. The amount of radioactive exposure from the test is less than you will normally receive inone day from nature. The test is quick and simple to perform, and much less expensive thanendoscopy. The USA version is called the "PYtest" and is described in detail at the Tri-Med/Ballardbreath-test internet site (http://www.trimed.com). The test costs $50-$100 and is also available inAustralia (http://www.trimed.com.au).
Carbon-13-urea Breath Test
In the C13-urea breath test you fast for about 6 hours (from midnight). A baseline breath sample iscollected (you blow into a bag or tube), then you eat a small, high calorie, meal ("ensure pudding"in the USA, it is somewhat like custard). Then you drink a solution of Carbon-13-urea in water.
Then breath samples are taken at intervals, usually 20 40 and 60 minutes later (it varies). Thesamples may be mailed to a testing lab. If H.pylori is present in your stomach the C13-urea will bebroken down and C13 will appear in your breath. Information about the test is available at theMeretek internet site (http://www.meretek.com) and also at this health information site(http://www.pslgroup.com/dg/2194a.htm). The test costs about $100.
Blood Tests for H.pylori
Blood tests check your blood to see if you have antibodies which stick to H.pylori
. If antibodies arepresent, it means either you have H.pylori
or have had it in the recent past (i.e. the past 3 yearsusually). To have this test done your doctor can draw a blood sample and send it to a lab to have ittested. Many national labs perform this test.
Recently, several companies have been working on rapid blood tests for H.pylori
which your doctorcan do in a few minutes in his office. Saliva tests to detect antibodies in saliva have also beendescribed.
Please Note: Antibody tests do not work well after you have been treated, since antibodies declineslowly and may remain elevated after H.pylori
has been killed. However, antibody tests are notaffected much if you have taken antibiotics, Pepto-Bismol, Prilosec, Carafate, Zantac, Tagamet, orPrilosec in the last month.
Endoscopy of the Stomach
Any gastroenterologist can do this test. A biopsy can be taken during endoscopy to check to see ifyou have H.pylori
. Once a biopsy has been obtained it can be examined by Gram stain andmicroscopy, a rapid urease test such as the CLOtest (see www.tri-med.com/clotest.html), orGiemsa stain or silver stain for histology. Remember, you should be off all antibiotics and/or Pepto-Bismol for one month, Prilosec or Carafate for one week and H2 Blockers such as Tagamet,Zantac or Pepsid for 24 hours before this test.
In this test you do not eat or drink for up to six hours. In the endoscopy room you are given aninjection of a sedative drug (similar to Valium) into a vein in the arm. A blood sample may be takenfrom the vein at this time. Your throat is sprayed with a local anaesthetic spray. You then swallow anarrow, flexible tube. The tube is only about the thickness of your little finger and although mostpatients have a little discomfort during the first five seconds of the test, once the tube has passedthe back of the throat, very little discomfort occurs. Through this tube (the endoscope), the doctorexamines the inside of the oesophagus (food pipe), stomach and duodenum. While in the stomach,it is usual to take up to ten small biopsy samples from the lining of the duodenum, stomach, andoesophagus. The complete endoscopy examination takes 15 minutes. After the test you may notdrive a car for the remainder of the day because you may be drowsy. It is also illegal to drive aftertaking sedative drugs.
Case Study #3-02 Patient: Medical History/Clinical Information: The patient is a 54 year old female admitted to the Emergency Room with upper G.I. bleeding. Her hemoglobin today is 7.4 gm/dl. NOTE: During out-patient testing performed two days ago, her hemoglobin and hematocrit were 11.2gm/dl and 33.1%. Transfusion/Pregnancy History: The patient was transfused with 2 units of red b
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