What Test to Evaluate for H pylori?

September 25, 2013

A 55-year-old man is admitted to the ICU with an upper GI bleed. Urgent endoscopy demonstrates a duodenal ulcer with recent stigmata of bleeding. He reports using NSAIDs occasionally for back pain and he takes a daily PPI for heartburn. Which of the following would be the recommended method to check for Helicobacter pylori?

A 55-year-old man is admitted to the ICU with an upper GI bleed. Urgent endoscopy demonstrates a duodenal ulcer with recent stigmata of bleeding. He reports using NSAIDs occasionally for back pain and he takes a daily PPI for heartburn. Which of the following would be the recommended method to check for Helicobacter pylori?

A. Rapid urease testing (CLO test)
B. Fecal antigen test
C. Serology antibody testing
D. Urea breath testing

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Answer: C. Serology antibody testing

In the setting of an upper GI bleed, the sensitivity of H pylori diagnostic testing decreases, to include breath testing and stool antigen testing. In addition, the use of PPIs can decrease the diagnostic sensitivity of urea-based tests. Therefore, in the setting of a recent luminal bleed secondary to peptic ulcer disease, the recommended strategy is to check for serology.