BLOOD TESTS FOR HELICOBACTER

Report #6706 1/20/96

More than 90% of stomach ulcers are caused by a bacteria called helicobacter pylori. A simple blood test is more dependable than a biopsy in diagnosing and treating an ulcer.

The symptoms of an ulcer are belching, having a burning feeling in the abdomen or chest that gets better with eating and worse when hungry/ and a sour taste in the mouth. It is no longer necessary for every person with these symptoms to have endoscopy or have a tube put down the mouth into the stomach and a having a piece of the stomach lining cut out and analyzed for helicobacter/ because a blood test is far more dependable. All people who are infected with helicobacter will have a positive blood test, but many people with helicobacter will have negative biopsies. Most of the time, the doctor will not see anything abnormal when he looks into the stomach and biopsies at random. Since the doctor may biopsy the wrong spot, he often misses the diagnosis. Three months after a person with ulcers is treated with appropriate antibiotics and cured, a blood test will show that the germ is gone. However, the biopsy cannot be used for follow up.

On rare occasions, belching and burning are caused by stomach cancer. To rule out a cancer, people with ulcer symptoms should get a special x ray called an upper GI series. Patients should receive endoscopy if they have a positive blood test for helicobacter and their symptoms continue after treatment or they cannot be cured of helicobacter.

By Gabe Mirkin, M.D., for CBS Radio News

1) NA Alsomal, KE Coley, PC Molan, BM Hancock. Role of Helicobacter Pylori Serology in Evaluating Treatment Success. Digestive Diseases and Sciences 1993 (Dec);38(12): 2262-2266.

2) WM Wang, CY Chen, CM Jan, LT Chen, DS Perng, SR Lin, CS Liu. Long term follow up and serological study after triple therapy of Helicobacter pylori associated duodenal ulcer. American Journal of Gastroenterology 89: 10(OCT 1994):1793-1796.

3) MA Mendall, RP Jazrawi, JM Marrero, N Molineaux, J Levi, JD Maxwell, TC Northfield. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut 36: 3 (MAR 1995):330-333. It is concluded that serology is the method of choice in screening before direct access upper gastrointestinal endoscopy in those under 45 years. It best combines a high sensitivity for peptic ulcer disease with a large reduction in unnecessary negative endoscopies.

4) MA Mendall, RP Jazrawi, JM Marrero, N Molineaux, J Levi, JD Maxwell, TC Northfield. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut 36: 3 (MAR 1995): 330-333.

5) Z Maratka. Endoscopic diagnosis of gastritis: Pros and Cons. Journal of Clinical Gastroenterology 20:2(MAR 1995):92-93. The endoscopic characteristics of inflammation in the stomach, in contrast to those of the esophagus and colon, are inconspicuous or lacking, ''Endoscopic gastritis'' does not correlate sufficiently with ''histologic gastritis'' and the term ''gastritis'' is to be limited to cases confirmed histologically.

6) CONCLUSIONS: Serology is a simple, noninvasive method of H pylori detection exhibiting good diagnostic accuracy. The Pyloriset EIA-A assay has test performance characteristics similar to the EIA-G. At one month posteradication therapy IgA, but not IgG, detection may be a good method of assessing : disappearance of H pylori. CA Fallone, GE Wild, CA Goresky, AN Barkun. Evaluation of IgA and IgG serology for the detection of Helicobacter pylori infection. Canadian Journal of Gastroenterology 9: 2(MAR-APR 1995):105-111.

7) This study shows that blood tests to diagnose helicobacter are also more cost effective and save a hell of a lot of money. Annals of Internal Medicine August 15, 1995;123:260-268.

8) BJ Marshall. Managing acid peptic disease in the Helicobacter pylori era. Journal of Clinical Gastroenterology 21: Suppl. 1(1995):S155-S159 The advent of new diagnostic and therapeutic modalities for Helicobacter pylori allows any physician to offer curative antibiotic regimens to patients with peptic ulcer disease and gastritis. In the new strategy, patients with dyspepsia are investigated with serology to detect those with H. pylori and potentially curable peptic ulcers. Patients with persistent symptoms require a urea breath test and only those who are now H. pylori-negative undergo endoscopy.