Twenty five years ago, many people have undergone major surgery because of gastric ulcer. Medications such as cimetidine were then developed problems effectively controlled, but must take the drug, which often suffer from various systems of the body over a long period of time. Recently, a bacterial infection with Helicobacter pylori (H.) was recognized as the main cause of ulcers. Not only helicobacter infection the main cause of peptic ulcer and gastritis, he was also associated with stomach cancer and mucosa associated lymphoid tissue (MALT) lymphoma. The body is in 20-40% of Canadians and the prevalence increases with age. Life risk of peptic ulcer disease in adult patients with helicobacter about twice as much as people without H.pylori. Guidelines and Protocols Advisory Committee (BCMA and the Ministry of Health) issued a document entitled Clinical approach to adult patients with dyspepsia (). The protocol stipulates that patients with alarm features (eg, bleeding) require immediate investigation endoscopy of the upper gastrointestinal tract and biopsy. Those patients who did not present with alarm symptoms are two options. (1) They can be checked for infection H.pylori. If the test is positive, the antibiotic elimination is required. If the test is negative, empirical therapy, consisting of 4-week course of histamine-2 receptors or proton pump inhibitor is recommended. (2) On the other hand, but more complicated empirical therapy can be used as the primary approach of UBS follow if necessary. Evaluation of successful treatment of Helicobacter pylori by using the urea breath test six weeks after a course of antibiotic therapy. There are several tests for the diagnosis of H.pylori. Serological: serological tests to determine the presence of antibodies to H.pylori. Positive serology indicates current or past infection H.pylori. A positive test does not confirm active disease. Negative serological test provides 95% assurance that there is no infection H. pylori. Serology should not be used in the evaluation of eradication of H. for antibody titer takes many months (or years) to decline. Urea breath test (MDT): patient asked to drink diluted solution containing urea labeled. H. pylori contains urease, an enzyme that breaks down urea into CO2 and NH3. CO2 then absorbed into the bloodstream and rapidly exhaled in breathing. The presence of labeled CO2 in the breath sample has 98% sensitivity and specificity of 99% for the presence of H.pylori. Two labels were used. C-14 is a beta-emitting radioactive isotopes with half-life of 5000 years, found beta-scintillation. C-13 is radioactive, stable isotope, which is measured by mass spectrometry. Biopsy culture and histology: biopsy is the gold standard. However, invasive, expensive and less sensitive (due to sampling error and failure of bacterial growth) than UBS. Other tests: salivary antigen detection was evaluated, but found that the accuracy is unacceptable for the diagnosis of infection H.pylori. Fecal antigen detection test was developed, but experience with the test needed to evaluate its clinical usefulness. Best Test C-13 UBS was recommended as the clinical gold standard against which other diagnostic methods may be updated. In children under two years, UBS may be difficult to manage and frontier strattera cost results are general. Persons with end-stage chronic obstructive pulmonary disease may not produce enough mixed samples of breath and not have to be checked. To assess the successful eradication of helicobacter UBS test is recommended six weeks of antibiotic therapy was discontinued. Hold UBS hitherto associated with both false positive and psevdonehatyvnyh results. The following may increase the risk of false negative results of UBS, therefore, to testing, the patient should:
fast and abstain from smoking for four hours,
to refrain from any antacids or symptomatic medication for at least two weeks
refrain from taking H2 inhibitors for one day
refrain from taking proton pump inhibitors (Losec, Prevacid, Pantoloc), at least three days
refrain from taking antibiotics for at least one month, and
wait six weeks after treatment with H.pylori. Links Veldhuyzen van Zanten SJO, and. other. Research-based approach to management unexplored dyspepsia in the era of helicobacter pylori. Can Med Assoc J 2000; 162 Appendix 12: 3-23. Bazzoli F, and. other. Urea breath test for detection of Helicobacter pylori infection. Helicobacter 1997; Supplement 2: S34-7. Fallone CA, and others. other. Urea breath test helicobacter infection, taking the wind out of sails endoscopy. CMAJ 16 May 2000, 162: 1401-2
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