Duodenal Ulcer: Test and Diagnosis

Laboratory parameters of the 2nd order – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification

  • Helicobacter pylori detection* .
    • Invasive methods:
      • Culture [sensitivity 70-90%, specificity 100%]
      • Histology (gold standard) after endoscopic biopsy (tissue sample) [sensitivity 80-98 %, specificity 90-98 %]
      • Urease rapid test (synonym: Helicobacter urease test; trade name: CLO test) – biopsy is thereby given into a urea-containing color indicator solution (bedside test) [sensitivity 90-95 %, specificity 90-95 %]Note: inhibition of enzyme activity (false negative test result) by proton pump inhibitors (proton pump inhibitors, PPI) and antibiotics; false-positive findings due to a bacterial (not H. pylori) overgrowth in the stomach Patient preparation: No therapeutic agents before biopsy (tissue sampling) (PPI 1 week, antibiotics 6 weeks).
      • Pathogen detection by PCR (polymerase chain reaction) [sensitivity 90-95%, specificity 90-95%].
    • Non-invasive methods:
      • 13C-urea breath test – indirectly measures the activity of the bacterial enzyme urease [sensitivity 85-95%, specificity 85-95%].
      • Stool antigen test using monoclonal antibodies [sensitivity 85-95%, specificity 85-95%]
      • IgG antibodies in serum [sensitivity 70-90%, specificity 70-90%]
  • Small blood count
  • Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
  • Secretin test (gastrin basal and after secretin) – to exclude gastrinoma in severe peptic ulcer disease.
  • Alpha-1 antitrypsin – for suspected alpha-1 antitrypsin deficiency.

* Therapy control: 13C-urea breath test with detection of labeled CO2 from H. pylori metabolism; in children as a non-invasive diagnostic or also for therapy control of the adult: Helicobacter pylori antigen detection in stool (6 to 8 weeks after end of therapy).