II. Indications

  1. Dyspepsia evaluation

III. Tests

  1. H. pylori culture
    1. Test Sensitivity: 70-80%
    2. Test Specificity: 100%

IV. Precautions

  1. Stop antibiotics for 4 weeks before Helicobacter Pylori testing
  2. Stop Proton Pump Inhibitors (PPIs) for 2 weeks before Helicobacter Pylori testing
  3. Only Serology and Rapid Urease Test are not affected by antibiotics and PPIs

V. Labs: Performed via Upper Endoscopy

  1. Histology (endoscopic biopsy) with Steiner's Stain
    1. Test Sensitivity: 70% (up to 95% in early studies)
    2. Test Specificity: 90% (up to 99% in early studies)
    3. Likelihood: LR+ 6.7, LR- 0.23
  2. Rapid Urease Test (e.g. CLO Test)
    1. Test Sensitivity: 67% (up to 93 to 97% in early studies)
    2. Test Specificity: 93%
    3. Likelihood: LR+ 9.6, LR- 0.31
  3. Helicobacter Pylori Culture (endoscopic biopsy sample)
    1. Test Sensitivity: 45% (up to 70-80% in early studies)
    2. Test Specificity: 98%
    3. Likelihood: LR+ 19.6, LR- 0.31
  4. References

VI. Advantages

  1. Gold standard for H. pylori diagnosis
  2. Confirms cure for H. pylori

VII. Disadvantages

  1. Requires endoscopic biopsy
  2. Sensitivity altered for histology and urease activity
    1. Proton Pump Inhibitors
    2. Antibiotics
    3. Bismuth

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