Evidence Based Pathology H pylori stool.ppt

Evidence Based PathologyH. pylori stool antigen test Shubnum Chaudhery Medical College of Georgia 12.7.06 Introduction First described in 1984 Curvilinear, Gram Negative Rod Colonizes gastric mucosa only over 200 genetically diverse strains identified Introduction Epidemiology Most prevalent infection world wide Commonly acquired during childhood 10% by age 10 60% by age 60 Low socioeconomic In U.S., more common in Blacks/Hispanics Transmission Route Fecal-oral Oral-oral Introduction Spectrum of H. pylori disease Asymptomatic infection in most (70%) Establishes a chronic infectious state Peptic ulcer disease and chronic gastritis in 15% of infected individuals Cofactor in development of gastric adenocarcinoma and mucosal associated lymphoid tissue lymphoma (MALT) European Helicobacter pylori Study Group (1987) Maastricht-3 2005 Consensus Report promote research in pathogenesis annual meetings task forces clinical trials Cochrane Systematic Review Five initial approaches to management of dyspepsia 1. Empirical acid suppression 2. Noninvasive HP testing 3. HP test treat 4. Empirical HP eradication 5. Early endoscopy Patients 55 or younger without alarm features should receive Hp test followed by acid suppression Hp testing should no longer be performed with serologic testing instead a Urea Breath Test or stool antigen test should be used Patients older than 55 with alarm features presenting with new dyspepsia or if upper GI malignancy is of concern then upper endoscopy is indicated (with biopsy) Mayo Clinic definition of Alarm Features in dyspepsia Age older than 55 years with new-onset dyspepsia Family history of upper GI cancer Unintended weight loss GI bleeding Progressive dysphagia Odynophagia Unexplained iron deficiency anemia Persistent vomiting Palpable mass or lymphadenopathy Jaundice Patients 55 years without alarm features H. pylori test treat followed by acid suppression if symptoms remain C-urea breath test or stool antigen test PPIs