With Endoscopy: Tissue Biopsy Sample Obtained Good Tests But Less Frequently Ordered Because Invasive
|Histology||Tissue examined under a microscope by a pathologist, who will look for H. pylori bacteria and any other signs of disease that may explain a person’s symptoms.|
|Rapid urease testing||H. pylori produces urease, an enzyme that allows it to survive in the acidic environment of the stomach. The laboratory test can detect urease in the tissue sample.|
|Culture||The bacteria are grown on/in a nutrient media results can take several weeks. This test is necessary if the healthcare practitioner wants to evaluate which antibiotic will likely cure the infection.|
|PCR||Fragments of H. pylori DNA are amplified and used to detect the bacteria primarily used in a research setting.|
The stool antigen test and urea breath test are recommended for the diagnosis of an H. pylori infection and for the evaluation of the effectiveness of treatment. These tests are the most frequently performed because they are fast and noninvasive. Endoscopy-related tests may also be performed to diagnose and evaluate H. pylori but are less frequently performed because they are invasive.
The testing recommendations come from guidelines by the American Gastroenterology Association , the American College of Gastroenterologists , and the Infectious Diseases Society of America / the American Society for Microbiology .
Should Everyone Be Tested For H Pylori
No, not everyone. You should be tested if you have ongoing dyspepsia or if you have an associated condition like peptic ulcers or stomach cancer. Testing for H. pylori is not needed for typical symptoms of acid reflux .
In a recent guideline update, the American College of Gastroenterology also suggests H. pylori testing if you are on long-term aspirin therapy or starting long-term NSAID therapy to help reduce the risk of developing ulcers and gastrointestinal bleeding. A Chinese study showed that patients with a history of bleeding ulcers and H. pylori infection who were also on low-dose aspirin were less likely to experience a recurrence of stomach bleeding when the infection was treated. Studies on patients taking NSAIDs have had mixed results. An analysis of the combined results of several of these studies showed that treating H. pylori infection reduced the number of ulcers in patients starting NSAID therapy, but not for patients already taking these medications. Its important to keep in mind that these studies dont provide the most definitive data. We dont know that testing everyone taking aspirin or NSAIDs long-term is cost-effective, so its best to talk with your doctor. Together you can determine your personal risk of ulcer bleeding against the cost and inconvenience of testing and risks of taking antibiotics.
What Happens Afterwards
The results of the breath test will be sent to a laboratory to be analysed and the results should be available in the department within a week. The consultant in charge of your care or your doctor will be informed of the result and they will decide what if there is a need for any action.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of GI Physiology on telephone: 624036
When Is It Ordered
Testing may be ordered when you have pain in your digestive tract and other signs and symptoms of an ulcer. Examples include:
- Abdominal pain that comes and goes over time
- Unexplained weight loss
- Feeling of fullness or bloating
Some people may have more serious signs and symptoms that require immediate medical attention, including sharp, sudden, persistent stomach pain, bloody or black stools, or bloody vomit or vomit that looks like coffee grounds.
H. pylori testing may also be ordered about 4 to 6 weeks after you have finished taking the prescribed antibiotics to confirm that the infection is cured. A follow-up test is not performed on every person, however.
H Pylori Test Cost With Insurance
Most of the health insurance policies in the U.S. cover the cost of the H Pylori blood test. However, the coverage offered by private health insurance companies and national health insurance programs like Medicare and Medicaid might vary. So we recommend you to check the coverage of your health insurance plan before getting tested for Celiac disease.
Our H Pylori testing providers do not accept any kind of health insurance plan. But, if the insurance company accepts to reimburse the cost, they can provide you with an itemized receipt containing all the details like the name and code of the test, and the CPT code that is necessary for insurance reimbursement purposes.
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What Is A Urea Breath Test
This is a simple breath test that can be used to determine whether or not you have an infection in your stomach caused by the bacteria helicobacter pylori.
The test involves blowing into 2 glass tubes using a plastic straw. After a first sample has been taken, you will be asked to drink 200mls of orange juice and the recommended urea powder solution.
Further breath samples will then be collected in the same way as the first. The test lasts approximately 40 minutes.
This test is completely safe and painless.
Treatment Of H Pylori Infection
Antibiotics and antacids are the mainstays of treatment for H. Pylori infection. Antibiotics like Clarithromycin and amoxicillin are best for H. Pylori infection.
In antacids, proton pump inhibitors like pantoprazole, lansoprazole and esomeprazole are best. Commercially, H. Pylori Treatment kits are available which is having fixed doses of Clarithromycin, amoxicillin, and pantoprazole.Duration of treatment is at least 2-3 weeks.
Along with medicines, certain lifestyle modifications like avoiding stress and tension avoiding oily and spicy food, avoiding large meals, weight reduction, smoking and alcohol deaddiction etc are also advisable.
Follow up: Your doctor might send you for follow up urea breath test after completion of treatment. If repeat test is negative then you are free from H. Pylori infection.
Dr. Kaushal M Bhavsar pursued his MD in Pulmonology. He is an Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad
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Diagnostic Accuracy And Clinical Applications
The 13C-UBT can be used in many clinical settings because of its non-invasiveness, simplicity, and safety. Furthermore, the sensitivity and specificity in untreated subjects are very high and range from 90 to 98% and from 92 to 100%, respectively.,,,,,, Accuracy in the assessment of eradicating efficacy is more controversial because some investigators found excellent reliability even in the post-treatment phase, whereas others did not confirm these good results. Accordingly, it has been recommended recently that two UBTs, performed at separate post-treatment time points , can equate to two different tests when assessing the success of anti-helicobacter treatments. Obviously, this applies to research trials on eradication treatments rather than to routine clinical practice.
Considering the above mentioned points, the UBT is the test of choice for screening patients before endoscopy, in epidemiological studies on the prevalence of H pylori infection in various populations, and in the non-invasive evaluation of the efficacy of eradication regimens. The other non-invasive test, serology, has relevant limits in assessing the success of anti-helicobacter regimens due to the considerable amount of time needed to show a consistent decrease in serum antibody levels. Lastly,13C-UBT is the ideal test for children, using a lower dose of urea provided that a mask is used, breath samples can be collected from those under three years of age.
What Happens During H Pylori Testing
There are different ways to test for H. pylori. Your health care provider may order one or more of the following types of tests.
- Checks for antibodies to H. pylori
- Test procedure:
- A health care professional will take a blood sample from a vein in your arm, using a small needle.
- After the needle is inserted, a small amount of blood will be collected into a test tube or vial.
Breath test, also known as a urea breath test
- Checks for infection by measuring certain substances in your breath
- Test procedure:
- You will provide a sample of your breath by breathing into a collection bag.
- After that, you will swallow a pill or liquid containing a harmless radioactive material.
- You will provide another sample of your breath.
- Your provider will compare the two samples. If the second sample has higher than normal carbon dioxide levels, it is a sign of an H. pylori infection.
Stool tests.Your provider may order a stool antigen or a stool culture test.
Endoscopy. If other tests did not provide enough information for a diagnosis, your provider may order a procedure called an endoscopy. An endoscopy allows your provider to look at your esophagus , the lining of your stomach, and part of your small intestine. During the procedure:
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What Is H Pylori
H. pylori is a bacteria that infects your stomach or duodenum . H. pylori bacteria can increase your risk of developing:
H. pylori is a major cause of peptic ulcer. The bacteria decreases the stomachs protective mucus. This makes it easier for the stomach to be damaged from digestive acids.
What Does The Test Result Mean
A positive H. pylori stool antigen, breath test, or biopsy indicates that your signs and symptoms are likely caused by a peptic ulcer due to these bacteria. Treatment with a combination of antibiotics and other medications will be prescribed to kill the bacteria and stop the pain and the ulceration.
A negative test result means that it is unlikely that you have an H. pylori infection and your signs and symptoms may be due to another cause. However, if symptoms persist, additional testing may be done, including the more invasive tissue biopsy, to more conclusively rule out infection.
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Approach For Patients In Relation To Alarm Symptoms
For patients with alarm features, early esophagogastroduodenoscopy is recommended . For those without alarm features, the decision is whether a trial of empiric proton pump inhibitor therapy or further diagnostic testing. In areas where H. pylori infections are common , a test for H. pylori and treatment of infected individuals are preferred over a trial of therapy with PPIs. In such regions, the test-and-treat H. pylori strategy has proven cost-effective and decreases the number of endoscopies. However, to test for H. pylori as a first-line strategy is reasonable even in areas with low prevalence of infection, given that the available tests are not invasive. Studies on economic modeling and symptoms improvement suggest that eradication therapy is a cost-effective strategy for managing functional dyspepsia and more data demonstrated that the treatment is particularly effective for patients with peptic ulcer-like symptoms .
Flow chart of the management of H. pylori for dyspeptic patients with dyspepsia.
In those in whom dyspepsia remains despite H. pylori eradication, a trial of PPI therapy is a reasonable next step. If symptoms persist, treatment with a prokinetic agent, antidepressant drugs or some form of alternative medications, might be considered, although evidence from prospective studies to support this approach is limited .
Helicobacter Pylori Urea Breath Test
NEW YORK DOH APPROVED: YES
CPT Code: 83013Alternative Names: Breath Test, UBiT, Urea Breath Test, H. pyloriABN Requirement: NoContainer: BreathTek UBT Collection Kit
- Follow instructions provided with BreathTek UBT Collection Kit
Note: This test can only be performed on specimens from patients > 17 years old. Patients 3-17 years of age must order Helicobacter pylori Urea Breath Test, Pediatric.
Fasting: Patient should fast one hour before collection of baseline breath sample.
Patient Preparation: Use of antimicrobials, proton pump inhibitors, or bismuth preparations within two weeks prior to administering the BreathTek UBT may cause a false negative result. However, a positive result is still valid. Pranactin®-Citric contains a small amount of aspartame sweetener. Test may not be suitable for patients with phenylketonuria whose dietary phenylalanine should be restricted.
Transport: Store BreathTek UBT Collection Kit bags at room temperature after collection and ship the same day per packaging instructions provided with the Cleveland HeartLab shipping box.
Note: Paired breath samples collected in BreathTek UBT Collection Kit bags must be submitted together. Follow instructions provided with kit.
Ambient : 7 daysRefrigerated : Not AcceptableFrozen : Not AcceptableDeep Frozen : Not Acceptable
Methodology: Infra-red Spectrophotometry
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What Steps Do I Need To Take Before The Procedure
Be sure to tell your healthcare provider if you are allergic to any medicines or if you are phenylketonuric. Follow these instructions:
- Four weeks before your test, do not take any antibiotics or Pepto-Bismol® .
- Two weeks before your test do not take any over-the-counter or prescription proton pump inhibitors, such as omeprazole , lansoprazole , pantoprazole , rabeprazole or esomeprazole , dexlansoprazole .
Do not stop taking any other medicine without first talking with your healthcare provider.
Food and drinks:
- One hour before the test, do not eat or drink anything .
On the day of the procedure
A healthcare provider will explain the procedure in detail and answer any questions you might have. The procedure lasts about 20 to 30 minutes.
After the procedure
- Your breath samples are sent to the laboratory where they are tested.
- You may resume your normal activities.
- No restrictions.
What Is The H Pylori Test
Helicobacter Pylori which is commonly known as H Pylori, is a type of spiral-shaped bacterium that causes infection in the stomach. H Pylori bacterium is one of the prime reasons for people having peptic ulcers, and it can also cause gastritis and has the potential to lead to stomach cancer.
As per the latest reports, about 30 40 percent of people in the United States get affected by H. pylori infection at least once in their lifetime. Not only grown adults get infected but also children are vulnerable to this bacterium. This infection does not cause symptoms unless it gets severe.
H pylori bacterium scrapes the inner protective coating in the stomachs and causes inflammation. In rare cases, this can lead to peptic ulcer, gastritis, or stomach cancer.
H pylori infection maintains a low profile and doesnt show any noticeable or sickness signs at the early stages. There is no vaccine to prevent oneself from it. However, H Pylori infection can be treated with antibiotics. If you experience symptoms like abdominal pain, frequent burping, your physician might ask you to get tested for H Pylori.
Is There Any Preparation Required Before The Test
For the blood test, there are no special preparations like fasting or diet control needed. You can continue with your regular activities and food intake.
As far as the stool sample test is concerned, you will be required to stop medications such as antibiotics and proton pump inhibitors before the test, if you are taking any. As it may influence the final result of the test. Other than this there are no other pre-requisites for the H Pylori stool test.
If you are opting to take the breath test, youll be asked to swallow a preparation liquid that contains urea during the test. At least one hour of fasting is necessary before taking the H Pylori breath test. Avoid consuming antimicrobials, proton pump inhibitors, or bismuth preparations for 2 weeks prior to the test.
Is Any Test Preparation Needed To Ensure The Quality Of The Sample
No special preparation is needed for the blood test.
For the urea breath test you must have nothing to eat or drink except a glass of water and your medication on the day of the test. Smoking is also not advised on the day of the test. Please follow any instructions you are given and inform you healthcare professional of any medications you are taking, as some medications will interfere with the test results, and the test may need to be rearranged.
If submitting a stool or having a biopsy you may be instructed to refrain from certain medications.
If undergoing endoscopy, you may be instructed to fast after midnight the night prior to the procedure.
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Potential Complications Of The Urea Breath Test
During post-approval use of the urea breath test, the following adverse events have been identified: anaphylactic reaction, hypersensitivity, rash, burning sensation in the stomach, tingling in the skin, vomiting and diarrhea. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to establish a causal relationship to drug exposure.
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Is Fasting Before Ubt Testing Necessary
However, the difference between DOB values in fasting and non-fasting conditions in some studies has been very small, or even inexistent. Some authors have demonstrated that relaxation of the fasting state does not reduce the accuracy of the UBT, making this test more convenient for patients.- Furthermore, some of these authors have demonstrated the equivalence of both protocols, in fasting and non-fasting conditions, in the same group of patients., ,
The use of citric acid as the test meal may result in a wider separation in DOB values between H. pylori-positive and H. pylori-negative patients . Thus, it has been suggested that a citric acid test meal may make the UBT more robust allowing a relaxation of the fasting state. In this respect, a randomized trial has recently shown that fasting before testing was unnecessary when citric acid was used instead of the pudding test meal. For UBT protocols without prior fasting, it has been shown that the determination of the best cut-off value for DOB depends on whether a test meal is used. In this respect, it has been suggested that, in case of performing the test in non-fasting conditions , it would be recommendable to decrease the cut-off point to consider a patient infected with the UBT.,
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