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DIAGNOSTICS

DIAGNOSTICS. CLINICAL INTEGRATION OCTOBER 27, 2009 PENAFLOR*QUINTO*RAMOS*SICAT* SUACO*TIO CUISON. Upper GI Endoscopy Aka esophagogastroduodenoscopy Indicated for all patients >45yo with dyspepsia or epigastric pain Minimally invasive Preferred test for PUD, highly sensitive

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DIAGNOSTICS

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  1. DIAGNOSTICS CLINICAL INTEGRATION OCTOBER 27, 2009 PENAFLOR*QUINTO*RAMOS*SICAT* SUACO*TIO CUISON

  2. Upper GI Endoscopy • Aka esophagogastroduodenoscopy • Indicated for all patients >45yo with dyspepsia or epigastric pain • Minimally invasive • Preferred test for PUD, highly sensitive • Visualizes the upper GI tract up to the duodenum

  3. Also allows for biopsy and cytologic brushing • Gastric ulcer may be malignant

  4. H. pylori testing • Rapid urease test – also endoscopic • Kit with a urea substrate and a pH sensitive indicator. • One or more gastric biopsy specimens are placed in the rapid urease test kit. If H pylori is present, bacterial urease converts urea to ammonia, which changes pH and produces a color change. • Histopathology • Culture – not for clinical use

  5. Non-endoscopic/non-invasive tests • Antibodies (immunoglobulin G [IgG]) to H pylori • serum, plasma, or whole blood • Urea breath tests • test for the enzymatic activity of bacterial urease • Fecal antigen testing • more accurate than antibody testing and is less expensive than urea breath tests.

  6. Special studies – not routinely done for PUD • A fasting serum gastrin level • screen for hypergastrinemia/Zollinger-Ellison syndrome, rule out gastrinoma • Indicated for: patients with multiple ulcers; ulcers occurring distal to the duodenal bulb; strong family history of PUD; peptic ulcer associated with diarrhea, steatorrhea, or weight loss; peptic ulcer not associated with H pylori infection or NSAID use; peptic ulcer associated with hypercalcemia or renal stones; ulcer refractory to medical therapy; and ulcer recurs after surgery. • Secretinstimulation test • can distinguish Zollinger-Ellison syndrome from other conditions with a high serum gastrinlevel

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