Helicobacter 3

Diagnostic of Helicobacter pylori

It is very important that prior to any breath testing (except serology, i.e. the H.pylori  antibody blood test) for H. pylori, you have not taken any antibiotics or Pepto Bismol /De-Nol for one month, Losec Nexium & other similar Proton Pump Inhibitors (PPI�s) for one week, or Pepsid, Zantac, Axid, or Tagamet & other such H2 receptor antagonists for 24 hours before the breath tests are done.

To decide which is the best treatment for H. pylori, it may be necessary to do an endoscopy and take a biopsy (a small piece of tissue) from the lining of the stomach. This allows your doctor to grow your H. pylori in the laboratory and decide which antibiotic to use.

Breath Test

In the C14-urea breath test, the breath sample is read in a scintillation counter. In the C13-urea breath test the breath sample is read in a mass spectrometer (MS) rather than a liquid scintillation counter (LSC

Carbon-14-urea Breath Test

In the Australian TGA & US-FDA approved C14-urea breath test you fast for about 6 hours (from midnight). The test is performed in the usually morning.

You swallow a capsule which contains one microCurie of C14-urea. You provide the breath sample usually by blowing up a small balloon or blowing bubbles in a small bottle of breath-collection liquid. Samples of breath are then taken 10 minutes after the capsule is swallowed. The C-14-urea contains a tiny amount of radioactive material which passes out of your body in a day or so in the urine and breath.

 The amount of radioactive exposure from the test is less than you will normally receive in one day from nature. (i.e. natural background radiation to which every individual on earth is exposed to everyday. The test is quick and simple to perform, and much less expensive than endoscopy.

The Australian & USA version is called the"PYtest" and is described in detail at the Tri-Med breath-test internet site (http://www.trimed.com.au). In Australia the test costs $AUD65 � $AUD80 but it is fully reimbursed by Medicare for all patients with a history of ulcer, previous H.pylori infection or for those patients unable to undergo endoscopy.

However, in July 2006 the Australian Medicare Services Advisory Committee (MSAC) has recommended that public funding should be supported for the use of carbon labelled urea breath testing (both C-14 & C-13) as the first line procedure for the diagnosis of H.pylori infection. In the USA the PYtest may cost $USD50 - $USD100.

Carbon-13-urea Breath Test

In the C13-urea breath test you fast for about 6 hours (from midnight). A baseline breath sample is collected (you blow into a bag or tube), then you eat a small, high calorie, meal ("ensure pudding" in the USA, it is somewhat like custard). Then you drink a solution of Carbon-13-urea in water.

Then breath samples are taken at intervals, usually 20 40 and 60 minutes later (it varies). The samples may be mailed to a testing lab. If H.pylori is present in your stomach the C13-urea will be broken down and C13 will appear in your breath. Information about the test is available at the Meretek internet site (http://www.meretek.com) and also at this health information site. The test costs about $100.

Carbon-14-urea Breath Test

In the Australian TGA & US-FDA approved C14-urea breath test you fast for about 6 hours (from midnight). The test is usually performed in the morning. You swallow a capsule which contains one microCurie of C14-urea. You provide the breath sample usually by blowing up a small balloon or blowing bubbles in a small bottle of breath-collection liquid.

Samples of breath are then taken 10 minutes after the capsule is swallowed. The C-14-urea contains a tiny amount of radioactive material which passes out of your body in a day or so in the urine and breath. The amount of radioactive exposure from the test is less than you will normally receive in one day from nature. (i.e. natural background radiation to which every individual on earth is exposed to everyday.

 The test is quick and simple to perform, and much less expensive than endoscopy. The Australian & USA version is called the"PYtest" and is described in detail at the Tri-Med breath-test internet site (http://www.trimed.com.au). In Australia the test costs $AUD65 � $AUD80 but it is fully reimbursed by Medicare for all patients with a history of ulcer, previous H.pylori infection or for those patients unable to undergo endoscopy.

However, in July 2006 the Australian Medicare Services Advisory Committee (MSAC) has recommended that public funding should be supported for the use of carbon labelled urea breath testing (both C-14 & C-13) as the first line procedure for the diagnosis of H.pylori infection. In the USA the PYtest may cost $USD50 - $USD100.

Carbon-13-urea Breath Test

In the C13-urea breath test you fast for about 6 hours (from midnight). A baseline breath sample is collected (you blow into a bag or tube), then you eat a small, high calorie, meal ("ensure pudding" in the USA, it is somewhat like custard). Then you drink a solution of Carbon-13-urea in water. Then breath samples are taken at intervals, usually 20 40 and 60 minutes later (it varies).

The samples may be mailed to a testing lab. If H.pylori is present in your stomach the C13-urea will be broken down and C13 will appear in your breath. Information about the test is available at the Meretek internet site (http://www.meretek.com) and also at this health information site. The test costs about $100.

Blood Test

Blood tests check your blood to see if you have antibodies which stick to H. pylori. If antibodies are present, it means that either you have a current infection of H. pylori OR you have had an infection of H.pylori in the recent past (i.e. the past 3 years usually). To have this test done your doctor can draw a blood sample and send it to a lab to have it tested. Many national labs perform this test.

However if the blood test is negative you can be reassured that you never had and you do not have an H.pylori infection. By the same token if your blood test is positive you cannot be certain that you have a current active H.pylori infection. Only a breath test will clearly indicate whether you have a current infection.

Recently, several companies have been working on rapid blood tests for H. pylori which your doctor can do in a few minutes in his office. Saliva tests to detect antibodies in saliva have also been described. However these are not very accurate.

Please Note: Antibody tests do not work well after you have been treated. The reason for this is that antibodies to H.pylori decline slowly and may remain elevated after H. pylori has been totally eradicated.. However, antibody tests are not affected much if you have taken antibiotics, Pepto-Bismol, Proton pump inhibitors (such as Prilosec, Zoton, Losec, Pariet Nexium, Somac etc.), cytoprotectives (such as Carafate,& sucralfate) and H2 receptor antagonists (such as Zantac, Tagamet,) in the last month

Endoscopy

    

Any gastroenterologist can do this test. It is a day-procedure in hospital. A biopsy is taken during endoscopy to check to see if you have H. pylori.

Once the biopsy has been obtained it is then sent to the hospital laboratory to be examined by Gram stain, Giemsa stain or silver stain for histology. A rapid urease test such as the CLOtest can be done while you are in the endoscopy suite and the results obtained within an hour before you leave the hospital.

The latter CLOtest investigation is rapid & useful as the doctor can prescribe the treatment before you leave the hospital after your day-procedure. 

Remember, it is very important that you cease all antibiotics including Pepto-Bismol/De-Nol one month prior to endoscopy. Prilosec or cytoprotective medications such as Carafate and Sucralfate must not be taken for one week prior to endoscopy and H2 Blocker-medications such as Tagamet, Zantac or Pepcid must not be taken for 24 hours before the procedure.

Prior to endoscopy you have to fast (no food or drink) for up to six hours. In the endoscopy room you are given an injection of a sedative drug (similar to Valium) into a vein in the arm. A blood sample may be taken from the vein at this time. Your throat is sprayed with a local anaesthetic spray.

Then a narrow, flexible tube is inserted through your mouth. The tube is only about the thickness of your little finger and although most patients have a little discomfort during the first five seconds of the test, once the tube has passed the back of the throat, very little discomfort occurs.

Through this tube (the endoscope), the doctor examines the inside of the oesophagus, stomach and duodenum. While in the stomach, it is usual to take up to ten small biopsy samples from the lining of the duodenum, stomach, and oesophagus. 

The complete endoscopy examination takes about 15 minutes. After the test you can not drive a car for the remainder of the day because you may be drowsy. It is also illegal to drive after taking sedative drugs.

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