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Diagnosis method of Helicobacter pylori infection in bleeding peptic ulcer
Varocha Mahachai1, Ratha-Korn Vilaichone, Pinit Kullavanijaya
1Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Diagnosing Helicobacter pylori (H. pylori) in peptic ulcer bleeding is crucial. Invasive tests are recommended for stable patients, while serology aids unstable cases for effective H. pylori eradication.
Area of Science:
- Gastroenterology
- Microbiology
- Surgical Oncology
Background:
- Peptic ulcer disease is a leading cause of upper gastrointestinal bleeding, with Helicobacter pylori (H. pylori) as the primary etiological factor.
- H. pylori eradication significantly reduces the rebleeding rate in patients with peptic ulcer bleeding.
- Identifying H. pylori status influences surgical decisions for bleeding peptic ulcers, differentiating between simple closure and more extensive procedures.
Purpose of the Study:
- To evaluate diagnostic strategies for H. pylori in patients with peptic ulcer bleeding.
- To determine the optimal H. pylori testing method based on patient stability and clinical context.
- To inform surgical management based on H. pylori status in bleeding peptic ulcer cases.
Main Methods:
- Proposed invasive testing (histology and rapid urease test) for stable bleeding peptic ulcer patients without coagulopathy.
- Recommended serology testing for unstable patients with bleeding peptic ulcers.
- Utilized histology and rapid urease test for initial H. pylori diagnosis in stable patients.
Main Results:
- In H. pylori-positive patients, further H. pylori investigation is unnecessary.
- Serology testing is effective for detecting H. pylori infection in unstable patients.
- Invasive testing combined with histology and rapid urease test is suggested for stable patients.
Conclusions:
- Accurate H. pylori diagnosis is vital for managing peptic ulcer bleeding and guiding surgical interventions.
- A combination of invasive tests is suitable for stable patients, while serology is effective for unstable patients.
- Timely H. pylori detection impacts treatment strategies and reduces rebleeding rates.
Abstract:
Peptic ulcer lesions are the most frequent cause of upper gastrointestinal bleeding and are responsible for more than 50 per cent of cases. Several etiologic factors of peptic ulcer are known, the principle one being Helicobacter pylori (H. pylori). Recent studies indicate that H. pylori eradication is associated with the marked reduction in rebleeding rate. In peptic ulcer bleeding which requires surgical intervention, knowledge H. pylori status may help to determine the choice of procedure (simple sewing in H. pylori positive patients vs full-blown ulcer surgery in H. pylori negative patients). We suggest to use the invasive combination of histology and biopsy-rapid urease test in stable bleeding peptic ulcer patients without coagulopathy for H. pylori diagnosis. Cases with positive result do not need further investigation for H. pylori diagnosis. If negative, the serology test was suggested to confirm the absence of H. pylori. However, in unstable patients, the serology test seem to effectively detect H. pylori infection.