- Suspected health concerns of a digestive nature affecting the upper gastrointestinal tract
- Patient has a wide variety of symptoms of unknown etiology
- Test specifically for H Pylori bacteria
The awareness of Helicobacter pylori in gastrointestinal diseases has increased greatly since Marshall and Warren described the presence of Campylobacter-like organisms in the antral mucosa of patients with histological evidence of antrum (upper portion of the stomach) gastritis and peptic ulcers, especially duodenal ulcers. The strong correlation between the presence of H. pylori and histologically confirmed gastritis, peptic ulcer disease and gastric carcinoma, as well as disease resolution after H. pylori eradication, indicates a causative relationship.
The ecological niche in humans appears to be restricted to the stomach and duodenum. Patients who harbor the organism are divided into two basic groups: a) colonized and b) infected. Patients who test positive for H. pylori yet have no signs or symptoms of gastrointestinal disease are considered “colonized”. Patients who test positive for H. pylori and present with signs or symptoms of gastrointestinal disease are considered “infected”. The process by which a colonized individual becomes infected remains unclear. The process by which patients become colonized is also still under investigation. Direct detection requires that an invasive biopsy be taken from the upper gastrointestinal tract. The presence of H. pylori is then confirmed by direct microscopic examination, rapid urease testing or culturing of the organism from the biopsy material. This strategy has the advantage of being able to detect active infections while being highly specific with a very high positive predictive value. The invasive approach subjects the patient to unnecessary risk and discomfort.