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Helicobacter pylori Noninvasive Testing

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81. Cellulitis (Overview)

factors for serious illness (eg, extremes of age, general debility, immunocompromise) The Infectious Disease Society of America (IDSA) recommends the following blood tests for patients with soft-tissue infection who have signs and symptoms of systemic toxicity [ ] : Blood cultures CBC with differential levels of creatinine, bicarbonate, creatine phosphokinase, and C-reactive protein (CRP) Blood cultures should also be done in the following circumstances [ ] : Moderate to severe disease [ ] (eg (...) , cellulitis complicating lymphedema [ ] ) Cellulitis of specific anatomic sites (eg, facial and especially ocular areas) Patients with a history of contact with potentially contaminated water [ ] Patients with malignancy who are receiving chemotherapy Neutropenia or severe cell-mediated immunodeficiency Animal bites Other tests to consider are as follows: Mycologic investigations are advisable if recurrent episodes of cellulitis are suspected to be secondary to tinea pedis or onychomycosis Creatinine

2014 eMedicine.com

82. Coronary Artery Atherosclerosis (Overview)

Intermittent claudication Mesenteric angina Tachycardia: Common in persons with acute coronary syndrome (ACS) and acute myocardial infarction (AMI) High or low blood pressure S 4 gallop: A common early finding S 3 gallop: An indication of reduced left ventricular function Heart murmurs Tachypnea Xanthelasmas Livedo reticularis Syncope Leg edema Rales See for more detail. Diagnosis Laboratory tests: Complete blood count (CBC) Chemistry panel Lipid profile Thyroid function tests: To exclude thyroid disorders (...) comorbidities than test subjects. The guideline is now “effectiveness-based” rather than “evidence-based.” Effectiveness-based considerations have reduced the strength of previous recommendations for use of aspirin, statins (in women with elevated C-reactive protein but normal cholesterol), and aggressive glycemic control in diabetes. The elderly and coronary artery disease Age is the strongest risk factor for the development of CAD. Most cases of CAD become clinically apparent in patients aged 40 years

2014 eMedicine.com

83. Bronchiectasis (Overview)

of gastroesophageal reflux is a risk factor for aspiration and that the organism Helicobacter pylori may play a role in the development of bronchiectasis in this group of patients. [ , , ] Cystic fibrosis CF is a multisystem disorder that affects the chloride transport system in exocrine tissues, primarily secondary to a defect in the CF transmembrane regulator (CFTR) protein. CF and its variants are the most common cause of bronchiectasis in the United States and other industrialized nations. CF is an autosomal (...) -expected prevalence, with a 4-fold higher rate of bronchiectasis than the general population. [ ] Overall, identifying the true frequency remains a challenge, given the lack of specific symptoms and lack of readily available noninvasive screening tests for population studies. Race-, sex-, and age-related demographics No racial predilection exists other than those that may be associated with socioeconomic status. Evidence suggests that non–CF-related bronchiectasis is more common and more virulent

2014 eMedicine.com

84. Duodenal Ulcers (Treatment)

testing for active H pylori infection may be used. Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease (PUD). Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers. Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated successfully (...) % of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy. Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [ ] since mother-to-child transmission

2014 eMedicine.com

85. Genetic and Inflammatory Mechanisms in Stroke (Treatment)

. Antimycobacterial HSP65 has been associated with atherosclerosis. [ , ] Atherosclerotic disease occurs as a consequence of antibody-mediated vascular endothelial cytotoxicity. [ ] Several chronic or persistent latent infections have been variably associated with atherogenesis and stroke. These agents include Chlamydia pneumoniae , Helicobacter pylori, HIV, herpes viruses, Treponema pallidum , Rickettsia rickettsiae , and Trypanosoma cruzi , among others. At present, no single organism has been consistently (...) of infections, including C pneumoniae , H pylori , Haemophilus influenzae , Mycoplasma pneumoniae , CMV, Epstein-Barr virus, and herpes simplex virus (HSV) types 1 and 2, were more likely to be associated with progression of atherosclerosis. [ ] In the NOMAS prospective cohort, a higher burden of antibodies to different agents, including C pneumoniae , H pylori , CMV, HSV-1, or HSV-2, was associated with maximum carotid plaque thickness and an approximate 40% increased risk of incident stroke

2014 eMedicine.com

86. Gastritis, Atrophic (Treatment)

measures to prevent infection are not established. Previous Next: Long-Term Monitoring Guidelines for follow-up care for cases of atrophic gastritis are not established. If the patient was treated for H pylori infection, confirm eradication. Perform evaluation of eradication at least 4 weeks after the end of treatment. Eradication may be assessed by noninvasive methods, such as the urea breath test. Follow-up care may be individualized depending on the findings during endoscopy. For example (...) pylori held in the United States, the recommendations for H pylori testing and treatment were broadened. H pylori testing and eradication of the infection also were recommended after resection of early gastric cancer and for low-grade mucosa-associated lymphoid tissue lymphoma. If H pylori is identified as the underlying cause of gastritis, subsequent eradication now is almost generally an accepted practice. Protocols for H pylori eradication require a combination of antimicrobial agents

2014 eMedicine.com

87. Gastritis, Chronic (Treatment)

If a patient was treated for H pylori infection, confirm that the organism has been eradicated. Evaluate eradication at least 4 weeks after the beginning of treatment. Eradication may be assessed by means of noninvasive methods such as the urea breath test or the stool antigen test. Follow-up may be individualized, depending on the findings during endoscopy. For example, if dysplasia is found at endoscopy, increased surveillance is necessary. For patients with atrophic gastritis or dysplasia, follow-up (...) for H pylori eradication were limited to peptic ulcer disease. However, the 1997 Digestive Health Initiative (DHI) International Update Conference on H pylori broadened the recommendations for H pylori testing and treatment. H pylori testing and eradication were also recommended after resection of early gastric cancer and for low-grade mucosa-associated lymphoid tissue (MALT) lymphoma. Furthermore, it is now widely accepted that if H pylori is identified as the underlying cause of gastritis

2014 eMedicine.com

88. Gastric Ulcers (Treatment)

testing for active H pylori infection may be used. Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease (PUD). Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers. Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated successfully (...) % of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy. Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [ ] since mother-to-child transmission

2014 eMedicine.com

89. Peptic Ulcer Disease (Treatment)

testing for active H pylori infection may be used. Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease (PUD). Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers. Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated successfully (...) % of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy. Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [ ] since mother-to-child transmission

2014 eMedicine.com

90. Liver Disease and Pregnancy (Treatment)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) ), intrahepatic cholestasis of pregnancy (ICP), and hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome. [ ] Liver disease such as acute viral hepatitis can occur in pregnancy, and pregnancy may occur in a patient with underlying chronic liver disease, including patients with cirrhosis and portal hypertension, and patients who have undergone liver transplantation. In the initial evaluation of a pregnant patient with abnormal liver tests, the American College of Gastroenterology (ACG

2014 eMedicine.com

91. Peptic Ulcer Disease (Overview)

patients with uncomplicated PUD, routine laboratory tests usually are not helpful; instead, documentation of PUD depends on radiographic and endoscopic confirmation. Testing for H pylori infection is essential in all patients with peptic ulcers. Rapid urease tests are considered the endoscopic diagnostic test of choice. Of the noninvasive tests, fecal antigen testing is more accurate than antibody testing and is less expensive than urea breath tests but either is reasonable. A fasting serum gastrin (...) in individual cases but is not needed routinely. For patient education resources, see as well as , , and . Previous References [Guideline] Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol . 2007 Aug. 102(8):1808-25. . Javid G, Zargar SA, U-Saif R, et al. Comparison of p.o. or i.v. proton pump inhibitors on 72-h intragastric pH in bleeding peptic ulcer. J Gastroenterol Hepatol . 2009 Jul. 24(7):1236-43. . Lai KC, Lam SK

2014 eMedicine.com

92. Liver Disease and Pregnancy (Overview)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) ), intrahepatic cholestasis of pregnancy (ICP), and hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome. [ ] Liver disease such as acute viral hepatitis can occur in pregnancy, and pregnancy may occur in a patient with underlying chronic liver disease, including patients with cirrhosis and portal hypertension, and patients who have undergone liver transplantation. In the initial evaluation of a pregnant patient with abnormal liver tests, the American College of Gastroenterology (ACG

2014 eMedicine.com

93. Gallbladder Cancer (Overview)

Helicobacter bilis in bile and biliary tract malignancies: H. bilis in bile from Japanese and Thai patients with benign and malignant diseases in the biliary tract. Jpn J Cancer Res . 2002 Jul. 93(7):842-7. . Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med . 2003 Apr 24. 348(17):1625-38. . Tsuchiya Y, Sato T, Kiyohara C, Yoshida K, Ogoshi K, Nakamura K. Genetic polymorphisms of cytochrome P450 (...) Gallbladder cancer is difficult to detect and diagnose. Signs and symptoms are not usually seen in the early stages of disease and often overlap with the symptoms of gallstones and biliary colic. Laboratory studies Some tests that may prove helpful in diagnosing gallbladder cancer include the following: Liver function tests CA 19-9 assay Carcinoembryonic antigen (CEA) assay Imaging studies Ultrasonography (US) is a standard initial study in patients with right upper quadrant pain. A mass can be identified

2014 eMedicine.com

94. Gastric Ulcers (Overview)

with uncomplicated PUD, routine laboratory tests usually are not helpful; instead, documentation of PUD depends on radiographic and endoscopic confirmation. Testing for H pylori infection is essential in all patients with peptic ulcers. Rapid urease tests are considered the endoscopic diagnostic test of choice. Of the noninvasive tests, fecal antigen testing is more accurate than antibody testing and is less expensive than urea breath tests but either is reasonable. A fasting serum gastrin level should (...) . For patient education resources, see as well as , , and . Previous References [Guideline] Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol . 2007 Aug. 102(8):1808-25. . Javid G, Zargar SA, U-Saif R, et al. Comparison of p.o. or i.v. proton pump inhibitors on 72-h intragastric pH in bleeding peptic ulcer. J Gastroenterol Hepatol . 2009 Jul. 24(7):1236-43. . Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention

2014 eMedicine.com

95. Genetic and Inflammatory Mechanisms in Stroke (Overview)

. Antimycobacterial HSP65 has been associated with atherosclerosis. [ , ] Atherosclerotic disease occurs as a consequence of antibody-mediated vascular endothelial cytotoxicity. [ ] Several chronic or persistent latent infections have been variably associated with atherogenesis and stroke. These agents include Chlamydia pneumoniae , Helicobacter pylori, HIV, herpes viruses, Treponema pallidum , Rickettsia rickettsiae , and Trypanosoma cruzi , among others. At present, no single organism has been consistently (...) of infections, including C pneumoniae , H pylori , Haemophilus influenzae , Mycoplasma pneumoniae , CMV, Epstein-Barr virus, and herpes simplex virus (HSV) types 1 and 2, were more likely to be associated with progression of atherosclerosis. [ ] In the NOMAS prospective cohort, a higher burden of antibodies to different agents, including C pneumoniae , H pylori , CMV, HSV-1, or HSV-2, was associated with maximum carotid plaque thickness and an approximate 40% increased risk of incident stroke

2014 eMedicine.com

96. Duodenal Ulcers (Overview)

with uncomplicated PUD, routine laboratory tests usually are not helpful; instead, documentation of PUD depends on radiographic and endoscopic confirmation. Testing for H pylori infection is essential in all patients with peptic ulcers. Rapid urease tests are considered the endoscopic diagnostic test of choice. Of the noninvasive tests, fecal antigen testing is more accurate than antibody testing and is less expensive than urea breath tests but either is reasonable. A fasting serum gastrin level should (...) . For patient education resources, see as well as , , and . Previous References [Guideline] Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol . 2007 Aug. 102(8):1808-25. . Javid G, Zargar SA, U-Saif R, et al. Comparison of p.o. or i.v. proton pump inhibitors on 72-h intragastric pH in bleeding peptic ulcer. J Gastroenterol Hepatol . 2009 Jul. 24(7):1236-43. . Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention

2014 eMedicine.com

97. Peptic Ulcer Disease (Follow-up)

testing for active H pylori infection may be used. Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease (PUD). Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers. Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated successfully (...) % of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy. Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [ ] since mother-to-child transmission

2014 eMedicine.com

98. Liver Disease and Pregnancy (Follow-up)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) ), intrahepatic cholestasis of pregnancy (ICP), and hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome. [ ] Liver disease such as acute viral hepatitis can occur in pregnancy, and pregnancy may occur in a patient with underlying chronic liver disease, including patients with cirrhosis and portal hypertension, and patients who have undergone liver transplantation. In the initial evaluation of a pregnant patient with abnormal liver tests, the American College of Gastroenterology (ACG

2014 eMedicine.com

99. Duodenal Ulcers (Follow-up)

testing for active H pylori infection may be used. Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease (PUD). Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers. Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated successfully (...) % of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy. Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [ ] since mother-to-child transmission

2014 eMedicine.com

100. Gastric Ulcers (Follow-up)

testing for active H pylori infection may be used. Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease (PUD). Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers. Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated successfully (...) % of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy. Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [ ] since mother-to-child transmission

2014 eMedicine.com

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