1. CLINICAL INTEGRATION OCTOBER 27, 2009 PENAFLOR*QUINTO*RAMOS*SICAT* SUACO*TIO CUISON DIAGNOSTICS

2. Upper GI Endoscopy  Aka esophagogastroduodenoscopy  Indicated for all patients >45yo with dyspepsia or epigastric pain  Minimally invasive  Preferred test for PUD, highly sensitive  Visualizes the upper GI tract up to the duodenum

5. Also allows for biopsy and cytologic brushing  Gastric ulcer may be malignant

6. H. pylori testing  Rapid urease test – also endoscopic  Kit with a urea substrate and a pH sensitive indicator.  One or more gastric biopsy specimens are placed in the rapid urease test kit. If H pylori is present, bacterial urease converts urea to ammonia, which changes pH and produces a color change.  Histopathology  Culture – not for clinical use

7. Non-endoscopic/non-invasive tests  Antibodies (immunoglobulin G [IgG]) to H pylori  serum, plasma, or whole blood  Urea breath tests  test for the enzymatic activity of bacterial urease  Fecal antigen testing  more accurate than antibody testing and is less expensive than urea breath tests.

8. Special studies – not routinely done for PUD  A fasting serum gastrin level  screen for hypergastrinemia/Zollinger-Ellison syndrome, rule out gastrinoma  Indicated for: patients with multiple ulcers; ulcers occurring distal to the duodenal bulb; strong family history of PUD; peptic ulcer associated with diarrhea, steatorrhea, or weight loss; peptic ulcer not associated with H pylori infection or NSAID use; peptic ulcer associated with hypercalcemia or renal stones; ulcer refractory to medical therapy ; and ulcer recurs after surgery.  Secretin stimulation test  can distinguish Zollinger-Ellison syndrome from other conditions with a high serum gastrin level