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Old 05-19-2013
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Default gyrus question gastroenterology 1

A 58-year-old man is evaluated for abdominal pain by his primary care physician. He reports severe stress at his job for the last 3 months and has since noted that he has epigastric pain that is relieved by eating and drinking milk. He has not had food regurgitation, dysphagia, or bloody emesis or bowel movements. He denies any symp-toms in his chest. Peptic ulcer disease is suspected. Which of the following statements regarding noninvasive testing for Helicobacter pylori is true?

A. There is no reliable noninvasive method to detect
H. pylori.
B. Stool antigen testing is appropriate for both diagnosis of and proof of cure after therapy for H. pylori.
C. Plasma antibodies to H. pylori offer the greatest sensitivity for diagnosis of infection.
D. Exposure to low-dose radiation is a limitation to the urea breath test.
E. False-negative testing using the urea breath test may occur with recent use of NSAIDs.
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Old 05-19-2013
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Old 05-19-2013
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Quote:
Originally Posted by blade View Post
B...........

The answer is D. Exposure to low-dose radiation is a limitation to the urea breath test.


Noninvasive testing for H. pylori infection is recom-mended in patients with suggestive symptoms and no other indication for endoscopy, e.g., GI bleeding, atypical symptoms.

Several tests have good sensitivity and specifi-city, including plasma serology for H. pylori, 14 C or 13 C-urea breath test, and the fecal H. pylori antigen test. Sensitivity and specificity are greater than 80% and greater than 90%, respectively, for serology, while the urea breath test and fecal antigen testing are greater than 90% for both.

Serology is not useful for early follow-up after therapy com-pletion, as antibody titers will take several weeks to months to fall.

The urea breath test, which relies on the presence of urease secreted by H. pylori to digest the swallowed radioactive urea and liberate 14 C or 13 C as part of ammonia, is simple and rapid. It is useful for early follow-up, as it requires living bacteria to secrete urease and produce a positive test. The limitations to the test include the requirement for ingestion of radioac-tive materials, albeit low dose, and false-negative results with recent use of PPI, antibi-otics, or bismuth compounds. Stool antigen testing is cheap and convenient, but is not established for proof of eradication.
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