2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification
- Small blood count
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT); alkaline phosphatase, bilirubin.
- Helicobacter pylori detection* by:
- 13C-urea breath test
- Histology (gold standard)
- Culture, serology: AK against Helicobacter pylori and CagA antigen (cytotoxin associated gene A antigen – virulence factor).
- Celiac disease serology: transglutaminase antibody (tTG) or endomysium antibody (EMA)/endomysium IgA and transglutaminase IgA.
- Transglutaminase-IgA antibodies (tissue transglutaminase, abbreviated tTG- Ak): sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e., a positive test result occurs) 74-100%, specificity (probability that actually healthy persons who do not have the disease in question are also detected as healthy in the test) 78-100%.
- Endomysium antibody (EMA): sensitivity 83-100%, specificity 95-100%; there is an association between the titer level and the degree of villous atrophy.
- Selective IgA deficiency (determination of total IgA) must be excluded beforehand (prevalence (disease frequency) 2%); because in the presence of IgA deficiency endomysium and transglutaminase IgA antibodies may not be detectable.
- Stool examination – to exclude dysbiosis (in this case, exclusion of small intestinal bacterial malabsorption).
* The eradication success should be monitored; this can be done by breath test or Helicobacter pylori antigen detection in stool (6 to 8 weeks after the end of therapy).
