Helicobacter pylori

Algorithm(s)

PDF algorithm(s) available at www.arupconsult.com.

Helicobacter pylori Testing Algorithm

Clinical Background

Previously known as Campylobacter pylori, Helicobacter pylori (H. pylori) is one of the most common bacterial pathogens in humans.

Epidemiology

Prevalence - depends on age, socioeconomic status and ethnic group
- Approximately 35% in U.S. population
- Highest prevalence - lower income, non-Caucasian population
- Lowest prevalence - middle, upper income, Caucasian population
Transmission - probably fecal-oral

Organism

H. pylori is a gram-negative, spiral-shaped, urease-positive, microaerophilic bacterium that infects the gastric epithelium
Causes chronic inflammation in most infected hosts, up to one-half of the world's population
Implicated as risk factor for gastric adenocarcinoma and gastric B-cell lymphoma

Risk Factors

Socioeconomic status - highest in lower income, non-Caucasian population
Age - lowest in young children
Ethnicity - lowest in Caucasians

Clinical Presentation

Dyspepsia
Gastritis
Abdominal pain
Peptic ulcer disease - gastric, duodenal
Cancer
- Gastric mucosa-associated lymphoid tissue lymphoma (MALT)
- Gastric cancer

Algorithm(s)

PDF algorithm(s) available at www.arupconsult.com.

Helicobacter pylori Testing Algorithm

Tests

Tests generally appear in the order most useful for common clinical situations

Test name: Helicobacter pylori Breath Test

ARUP #: 0020646

Methodology: Infrared Spectrophotometric

Use:

Initial test to determine if H. pylori is causing active infection

Monitor H. pylori infection in adult patient post treatment

Limitations:

Negative result does not rule out possibility of H. pylori infection; if clinical signs suggest H. pylori infection, retest with new sample or alternate method

Known causes of false-negative results include:
- Use of antimicrobials, proton pump inhibitors and bismuth preparations within 2 weeks preceding test
- Administration of breath test < 4 weeks after completion of therapy to eradicate H. pylori
- Premature or late collection of post-dose sample

Known causes of false-positive results include:
- Patient with achlorhydria
- Procedures for test administration not followed correctly
- Presence of other gastric spiral organisms such as Helicobacter heilmannii

13C and 14C breath tests are noninvasive, but expensive due to need for special equipment

Follow-up:

Test name: Helicobacter pylori Antigen, Stool

ARUP #: 0065147

Methodology:

Use:

Determine whether H. pylori has been eradicated and not just temporarily suppressed, especially in adult patients with complicated, recurrent or refractory peptic ulcers; antigen testing should be performed no sooner than 1 month after all therapy stopped

Limitations:

Follow-up:

Test name: Helicobacter pylori Antibodies, IgG & IgA

ARUP #: 0050994

Methodology: Enzyme Immunoassay

Use:

Determine if H. pylori is causing active infection

Limitations:

May require repeat testing if results equivocal and clinical suspicion present

Follow-up:

Test name: Immunohistochemistry Stain Offering

ARUP #: arup005

Methodology: Immunohistochemistry

Use:

For fixed tissue samples, consultative services as well as immunohistochemical staining for the presence of H. Pylori are available

Additional Tests Available

Test name: Helicobacter pylori Antibody, IgA

ARUP #: 0050995

Methodology: Enzyme Immunoassay

Comments:

Test name: Helicobacter pylori Antibody, IgG

ARUP #: 0099359

Methodology: Enzyme Immunoassay

Comments:

Test name: Helicobacter pylori Antibody, IgM

ARUP #: 0098392

Methodology: Enzyme-Linked Immunosorbent Assay

Comments:

References

Guidelines

Bourke B, Ceponis P, Chiba N, Czinn S, Ferraro R, Fischbach L, Gold B, Hyunh H, Jacobson K, Jones NL, Koletzko S, Lebel S, Moayyedi P, Ridell R, Sherman P, van Zanten S, Beck I, Best L, Boland M, Bursey F, Chaun H, Cooper G, Craig B, Creuzenet C, Critch J, Govender K, Hassall E, Kaplan A, Keelan M, Noad G, Robertson M, Smith L, Stein M, Taylor D, Walters T, Persaud R, Whitaker S, Woodland R. Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation. Can J Gastroenterol. 2005;19(7):399-408.

General References

Chey WD, Fendrick AM. Noninvasive Helicobacter pylori testing for the "test-and-treat" strategy: a decision analysis to assess the effect of past infection on test choice. Arch Intern Med. 2001;161(17):2129-2132.

Cirak MY, Akyon Y, Megraud F. Diagnosis of Helicobacter pylori. Helicobacter. 2007;12 Suppl 1:4-9.

Delaney BC, Moayyedi P, Forman D. Initial management strategies for dyspepsia. Cochrane Database Syst Rev. 2003;(2):CD001961.

Dzierzanowska-Fangrat K, Lehours P, Megraud F, Dzierzanowska D. Diagnosis of Helicobacter pylori infection. Helicobacter. 2006;11 Suppl 1:6-13.

Franceschi F, Gasbarrini A. Helicobacter pylori and extragastric diseases. Best Pract Res Clin Gastroenterol. 2007;21(2):325-334.

Lehours P, Yilmaz O. Epidemiology of Helicobacter pylori infection. Helicobacter. 2007;12 Suppl 1:1-3.

Louw JA. Peptic ulcer disease. Curr Opin Gastroenterol. 2006;22(6):607-611.

Makristathis A, Hirschl AM, Lehours P, Megraud F. Diagnosis of Helicobacter pylori infection. Helicobacter. 2004;9 Suppl 1:7-14.

O'Brien SJ, Halder SL. GI Epidemiology: infection epidemiology and acute gastrointestinal infections. Aliment Pharmacol Ther. 2007;25(6):669-674.

Plebani M, Basso D. Non-invasive assessment of chronic liver and gastric diseases. Clin Chim Acta. 2007;381(1):39-49.

Pritchard DM, Crabtree JE. Helicobacter pylori and gastric cancer. Curr Opin Gastroenterol. 2006;22(6):620-625.

Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76(7):1005-1012.

Ricci C, Holton J, Vaira D. Diagnosis of Helicobacter pylori: invasive and non-invasive tests. Best Pract Res Clin Gastroenterol. 2007;21(2):299-313.

Saad RJ, Chey WD. Breath tests for gastrointestinal disease: the real deal or just a lot of hot air?. Gastroenterology. 2007;133(6):1763-1766.

Shah R. Dyspepsia and Helicobacter pylori. BMJ. 2007;334(7583):41-43.

Talley NJ, Vakil NB, Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology. 2005;129(5):1756-1780.

Talley NJ. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005;129(5):1753-1755.

Vilaichone RK, Mahachai V, Graham DY. Helicobacter pylori diagnosis and management. Gastroenterol Clin North Am. 2006;35(2):229-247.

Medical Reviewers

Grenache, David G., Ph.D. Medical Director, Special Chemistry at ARUP Laboratories; Assistant Professor, Clinical Pathology, University of Utah

Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah

Petti, Cathy A., M.D. Medical Director, Infectious Diseases at ARUP Laboratories; Assistant Professor, Pathology and Medicine, University of Utah

Comprehensive Review: March 2008
Last Update: July 2008