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Wednesday, April 6, 2022

Helicobacter pylori testing ( H. pylori ): Test Explanation, Indication, Procedure, Nursing Considerations by Nurses Note

 Helicobacter pylori testing ( H. pylori )


 (Study type: Stool for antigen testing; nuclear scan for urea breath analysis; endoscopy for stomach tissue biopsy with microscopic examination and culture of tissue; related body system: Digestive and Immune systems.) H. pylori is a bacterium that can infect the stomach lining and interfere with the ability of the stomach lining to produce mucous. There is a strong association between H. pylori infection and gastric cancer, duodenal and gastric ulcer, and chronic gastritis. Tests recommended for diagnosis and therapeutic monitoring of H. pylori infection include the stool antigen and urea breath tests. These two tests provide noninvasive, rapid results and are recommended by the American Gastroenterological Association and the American College of Gastroenterology as tests appropriate for diagnosis and confirmation that the infection has been effectively treated and the bacteria have been eliminated. The presence of H. pylori can also be demonstrated in endoscopic tissue biopsy samples or tissue cultures; drawbacks include the invasive specimen collection procedure, the time required to prepare and examine the tissue, and the time required to produce culture results. Blood tests for antibodies to H. pylori are available but seldom requested because they are no longer considered to be clinically useful. Patients with symptoms and evidence of H. pylori infection are considered to be infected with the organism; patients who demonstrate evidence of H. pylori but are without symptoms are said to be colonized. 

The C-14 UBT is an accurate way to identify the presence of H. pylori. It is a simple, non-invasive diagnostic nuclear medicine procedure that requires the patient to swallow a small amount of radiopharmaceutical C-14–labelled urea in a capsule with lukewarm water. In the presence of urease, an enzyme secreted by H. pylori in the gut, the urea in the capsule is broken down into nitrogen and C-14–labelled carbon dioxide (CO2). The labelled CO2 is absorbed through the stomach lining into the blood and excreted by the lungs. Breath samples are collected 10 to 15 min after the capsule has been ingested and trapped in a Mylar balloon. The C-14 urea is counted and quantitated with a liquid scintillation counter. The UBT can also be used to indicate the elimination of H. pylori infection after treatment with antibiotics. When the organism has been effectively treated with antibiotics, the test changes from positive to negative.

A stool antigen test may be used to identify the presence of H. pylori. This is an accurate test and may be requested for patients who are unable to cooperate for the UBT.

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Examination of tissue biopsy, obtained by endoscopy, from the lining of the stomach is another way to identify the presence of H. pylori. Biopsy specimens may be taken from multiple sites of the stomach lining, such as the lesser and greater curvatures of the antrum (each in close proximity to the pylorus), the lesser curvature of the corpus, the middle of the greater curvature of the corpus, and the incisura angularis. The samples are tested for urease activity and are histologically examined for the presence of inflammatory epithelial cells in the presence of the characteristically curve-shaped H. pylori bacteria. Additionally, tissue samples or brushings may be cultured for the presence of H. pylori. Sensitivity testing of positive cultures is helpful in identifying the most effective antibiotic, especially in patients who do not respond to therapy.


 H. pylori. antibody test; H. pylori stool antigen test; H.pylori breath test; urea breath test (UBT) PY test; C-14 urea breath test; rapid urease test (RUT is also known as the CLO, or Campylobacter-like organism test).


 To assist in diagnosing a gastrointestinal infection and ulceration of the stomach or duodenum related to a H. pylori infection.


 Instruct the patient to fast and restrict fluids for 6 to 8 hr prior to the UBT or tissue biopsy procedure. Additionally, patients scheduled for a UBT, stool antigen test, or tissue biopsy and culture may be instructed to avoid the use of proton pump inhibitors (e.g., omeprazole, lansoprazole, esomeprazole), antacids, antibiotics, or oral bismuth subsalicylate (Pepto Bismol); instructions for withholding medications are by medical direction. Protocols may vary among facilities. 


 Method: Enzyme immunoassay for stool antigen test, negative. UBT: Less than 50 dpm (disintegrations per minute) is considered a negative finding. Tissue biopsy and culture, negative for H. pylori.

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• Aid in detection of H. pylori infection in the stomach.

• Assist in differentiating between H. pylori infection and NSAID use as the cause of gastritis or peptic or duodenal ulcer.

• Assist in establishing a diagnosis of gastritis, gastric cancer, or peptic or duodenal ulcer.

• Monitor eradication of H. pylori infection following a treatment regimen.

• Evaluate new-onset dyspepsia.



Patients who are pregnant or suspected of being pregnant, unless the potential benefits far outweigh the risk of an endoscopic procedure or radiation exposure to the fetus and mother.

Patients who have taken antibiotics, Pepto-Bismol, or bismuth in the past 30 days.

Patients who have taken sucralfate in the past 14 days.

Patients who have used a proton pump inhibitor within the past 14 days.

Other considerations

• Patients who have had resective gastric surgery have the potential for resultant bacterial overgrowth (non–H. pylori urease), which can cause a false-positive result.

• Achlorhydria can cause a false-positive result.



Positive findings in stool Antigen Test, Direct Examination of Stomach Tissue, or Culture of Tissue Samples

• H. pylori infection

• H. pylori colonization

Urea Breath Test Helicobacter pylori testing ( H. pylori )

• Indeterminate for H. pylori: 50 to 199 dpm.

• Positive for H. pylori: Greater than 200 dpm.



Teaching the Patient What to Expect

➧ Inform the patient that the test is used to assist in the diagnosis of H. pylori infection in patients with duodenal and gastric disease; it is also used for monitoring therapy and documentation that the infection has been healed.

➧ Explain that the sample required will depend on the healthcare provider (HCP)’s choice of test (e.g. stool, tissue, or breath).

Stool Antigen Test

➧ Instruct the patient or caregiver to collect a solid stool sample in a clean, leakproof plastic container. Watery or diarrheal specimens are not acceptable.

Urea Breath Test

➧ Review the procedure with the patient. Address concerns about pain and explain that there should be no discomfort during the procedure. 

➧ Explain that the procedure is done in the nuclear medicine department by technologists and support staff and usually takes approximately 30 to 60 min.

➧ Pregnancy is a general contraindication to procedures involving radiation. Explain to the female patient that she will be asked the date of her last menstrual period and pregnancy testing may be performed to determine the possibility of pregnancy before she is exposed to radiation. 

➧ Reassure the patient that the radionuclide poses no radioactive hazard and rarely produces adverse effects. 

➧ Explain that at the beginning of the procedure, a breath sample will be obtained by blowing into a balloon. 

 Next, the patient will be instructed to swallow the C-14 capsule directly from a cup, followed by 20 mL of lukewarm water. An additional 20 mL of lukewarm water is to be drunk 3 min after the dose.

➧ Breath samples will be taken at different periods of time. Patients will be instructed to take in a deep breath and hold it for approximately 5 to 10 sec before exhaling through a straw into a Mylar balloon.

➧ Samples from the balloon are counted on a scintillation counter and recorded in disintegrations per minute. 

Potential Nursing Actions 

Endoscopic Biopsy Sample

➧ The laboratory should be consulted regarding the appropriate transport container, preservative, or culture medium for tissue samples.


Treatment Considerations

➧ Chronic pain and emotional factors associated with illness can contribute to fatigue. When fatigue is present, pace activities to preserve energy stores, identify what aggravates and decreases fatigue, and assess for physiologic factors such as anaemia. Monitor for black tarry stools that are indicative of bleeding, and facilitate interventions such as blood transfusion or antiemetic and antidiarrheal medication.

➧ Facilitate adequate pain management to identify the best modality to provide relief. Administer ordered proton pump inhibitors, antibiotics, H2 receptor antagonists, and antacids. Safety Considerations

➧ The patient who is pregnant or breastfeeding should consult with the requesting HCP regarding alternate testing that does not involve radiation. The safety of some C-14 UBT methods for pregnant or lactating women is not well established. The C-13 test is nonradioactive and considered safe for pediatric patients, pregnant patients, or patients who are breastfeeding.


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Nutritional Considerations

➧ Encourage the avoidance of alcoholic and caffeinated beverages. Consider consultation with a registered dietitian to assess cultural food selections and barriers to eating.

Follow-Up, Evaluation, and Desired Outcomes

➧ Acknowledges education provided regarding the disease, factors that can trigger symptoms, and possible treatment options that may include surgery.

➧ Understands that a positive test result constitutes an independent risk factor for gastric cancer.

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