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Helicobacter pylori Noninvasive Testing

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101. Gastritis, Atrophic (Follow-up)

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

102. Gastritis, Chronic (Follow-up)

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

103. Coronary Artery Atherosclerosis (Follow-up)

and Forrester Chest Pain Prediction Rule: For example, in patients with suspected CAD using the new criteria, if the PTP is < 15%, investigate other possible causes and consider a diagnosis of functional coronary disease; if the PTP is intermediate (eg, 15%-85%), send the patient for noninvasive testing; if the PTP is high (eg, >85%), a diagnosis of CAD is established, and patient risk stratification should follow In stable CAD, the functional impact of coronary lesions relative to their angiographic (...) to less than 70 mg/dL did not lead to further improvement in graft patency. [ ] Statin therapy is also safe and can improve liver tests while reducing cardiovascular morbidity in patients with mild- to moderately-abnormal liver test results that may be attributable to nonalcoholic fatty liver disease. [ ] In the United States, the most commonly used guidelines for cholesterol management are those from the NCEP Adult Treatment Panel (ATP). In high-risk persons, the recommended LDL-C goal is less than

2014 eMedicine.com

104. Genetic and Inflammatory Mechanisms in Stroke (Follow-up)

. 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

105. Gastritis and 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 Emergency Medicine

106. Cellulitis (Diagnosis)

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

107. Cellulitis (Diagnosis)

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

108. Genetic and Inflammatory Mechanisms in Stroke (Diagnosis)

. 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

109. Duodenal Ulcers (Diagnosis)

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

110. Bronchiectasis (Diagnosis)

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

111. Perioperative Management of the Patient With Liver Disease

capacity (metabolic equivalent [MET] or exercise duration). Additional noninvasive testing such as stress testing might be considered if it will change perioperative management. Cardiac surgery performed in patients with cirrhosis is associated with a high surgical mortality rate and will be discussed separately. [ ] In 1997, the American College of Physicians (ACP) published guidelines in the form of algorithms for assessing and managing perioperative risks based on the results of the tests mentioned (...) the treatment of choice for managing cases of refractory variceal bleeding, and surgical shunts are created only in special circumstances. Percutaneous stenting or endoscopic retrograde cholangiopancreatography (ERCP) is now commonly used for biliary strictures and choledocholithiasis. Coronary angioplasty and percutaneous coronary interventions have decreased the need for coronary artery bypass grafting (CABG). The use of proton-pump inhibitors (PPIs) along with antibiotic treatment of Helicobacter pylori

2014 eMedicine.com

112. Gallbladder Cancer (Diagnosis)

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

113. Gastric Ulcers (Diagnosis)

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

114. Coronary Artery Atherosclerosis (Diagnosis)

Stable angina pectoris 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 (...) 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

115. Peptic Ulcer: Surgical Perspective (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 Pediatrics

116. 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 Pediatrics

117. Peptic Ulcer: Surgical Perspective (Overview)

.) In most 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 (...) 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 Pediatrics

118. 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 Pediatrics

119. Gastritis and Peptic Ulcer Disease (Diagnosis)

.) In most 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 (...) 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 Emergency Medicine

120. Cellulitis (Diagnosis)

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 Emergency Medicine

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