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In Patients with Peptic Ulcer Disease, What Is the Most Accurate Diagnostic Test to Determine the Presence of Helicobacter pylori Prior to Treatment?

15 August 2009


INTRODUCTION: Helicobacter Pylori is a common bacteria found in the stomach that can cause ulcers and more rarely gastric cancer. There are multiple diagnostic tests that are currently available to detect this microorganism possibly making it difficult for providers to choose the most accurate or inexpensive test. It is important to diagnosis H. pylori in symptomatic patients due to the potential of eliciting a series of pathologic consequences in the extra-gastric regions. These consequences have been studied at length and can include cardiovascular and autoimmune disorders as well as certain digestive disorders such as liver disease.

METHODS: There are five diagnostic tests reviewed in this study including urea breath test, stool antigen assay, rapid urease test, serology and histology. An exhaustive literature search was performed using multiple search databases including Medline, CINAHL, PubMed and Evidence Based Medicine Review Multifile. Literature from the past 15 years was reviewed and evaluated to determine the most accurate and cost effective testing for the diagnosis of H. pylori. Complete analysis of each article was performed to determine the most relevant information regarding this topic. Article inclusion criteria included all relevant articles discussing the adult population in the English language, published after 1995, that assisted the author in the determination of the most appropriate test for a dyspeptic patient. Exclusion criteria were articles published before 1995 and ones that discussed patients under the age of 18.

RESULTS: Four studies were found to meet the inclusion and exclusion criteria as well as stating clear and precise data concerning the diagnostic tests needing to be examined.

CONCLUSION: For accurate results when a patient does not need an endoscopy or refuses such an invasive procedure, urea breath testing is the best choice for the diagnosis of H. pylori. Other diagnostic tests such as serology and stool antigen testing has been shown to either have a low accuracy rate or too many variables that can affect the outcome of the test.


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