Question

A 56-year-old woman presents with heartburn and dyspepsia. She was diagnosed with osteoarthritis 4 years prior to presentation, and for the past 18 months, she has been managing pain with naproxen. An upper gastrointestinal endoscopy shows several areas of gastric irritation and a single ulcer about 3 mm in diameter. The gastroenterologist suggests that the patient be tested for Helicobacter pylori infection. What is the gold standard for diagnosis of this infection?

1 Culture
2 Histology
3 Antigen test
4 Western blot serology
5 Urease breath test

Answer 1

The gold standard for diagnosing Helicobacter pylori infection is histology, a biopsy-based testing method used during endoscopy, even though urease breath tests are also accurate and non-invasive.

Step-by-step explanation:

The gold standard for diagnosing Helicobacter pylori infection is confirmed through biopsy-based testing, specifically histology. This method involves taking a tissue sample from the stomach and examining it under a microscope to identify the presence of H. pylori bacteria. The procedure is typically performed during an endoscopic examination. Other tests like the urease breath test, stool antigen test, serological testing for antibodies, and bacterial culture are also used, but histology remains the most definitive diagnosis method.

While the urease breath test is non-invasive and quite accurate, it does depend on the metabolic activity of the bacteria breaking down urea into carbon dioxide that can be detected. However, for a conclusive diagnosis, and frequently after an endoscopy has shown the presence of gastric irritation and ulcers as in the case presented, histology is the preferred method.