Which lab tests are used to identify H pylori in the workup of acute gastritis?

Updated: Jun 13, 2019
  • Author: Mohammad Wehbi, MD; Chief Editor: BS Anand, MD  more...
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A number of H pylori tests are available. They are classified as either nonendoscopy based or endoscopy based.

Three nonendoscopy-based H pylori tests are available, as follows:

  • The first test is the H pylori stool antigen test (HpSA). This test is based on the detection of the H pylori antigen in the stool. It has sensitivity and specificity of greater than 90%. It can be used for both the diagnosis of H pylori and the confirmation of eradication after therapy.

  • The second test is the urea breath test. It uses 13C- or 14C-labeled urea taken orally. H pylori metabolizes the urea and liberates labeled carbon dioxide that is exhaled. This, in turn, can be quantified in breath samples. The sensitivity and specificity of the urea breath test is greater than 90%. This is considered the noninvasive diagnostic method of choice in situations where endoscopy is not indicated. It can also be used to confirm eradication after therapy

  • The third test depends on the presence of antibodies to H pylori in the serum. The major drawback to this test is that serologic assays may remain positive for as long as 3 years after eradication of the bacteria. Therefore, serologic assays are often unreliable to document eradication of H pylori. This test can be used for the diagnosis of H pylori, provided that the patient has not received any prior therapy for it.

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