What do we look for?

What do we look for? Basically what this test is looking for is the urease – the enzyme that’s produced by the H. pylori itself – and that cleaves to give them radioactive urea. It cleaves the urea, you get radioactive carbon dioxide, they breathe it out into the balloon and we look for the radioactive carbon dioxide.
Remember when you treat H. pylori, you are committing yourself to a multi drug antibiotic regimen. I’m sure it’s not quite as bad as TB, which we just heard about, but it’s still not an innocuous set of drugs. Flagyl, in particular, can have quite a few side effects. It’s also, for many weeks. I don’t know about you but I had to be on a multi drug regimen once and even knowing just how critical it was to take all those drugs as scheduled it was still very difficult for me to do that. Don’t forget to use your acid reducers or your H2 antagonists to also treat the ulcer while you’re treating the H. pylori and it is critical to prevent recurrence of the ulcer.
Again, other diagnostic modalities. We discussed the indication for the CLO test. The C13 breath test is very similar to ours. It’s not a radioactive version of carbon but it’s a heavier version and you use mouse spectroscopy in order to identify the carbon-13 labeled CO2. Because of that mouse spectroscopy, it is a more time consuming test. I understand they charge in the same ballpark as our study.
Serum antibodies are helpful. However, they remain positive for quite awhile after you’ve even treated the infection. It does not necessarily indicate acuity and it’s particular poor for following response to therapy.
HIDA scans. I’m going to just briefly tell you a little bit about gall bladder ejection fraction. Again, think of the gall bladder as basically a muscular sac. It needs to relax, dilate, contain the bile, store the bile, and then upon stimulation by CCK, it needs to then contract and eject the bile into the small intestine. So if it cannot do that, that evidence of dysfunction has been associated with chronic cholecystitis. Patients that have right upper quadrant pain and a low ejection fraction who do have a cholecystectomy, 90% of them have complete and permanent resolution of their right upper quadrant pain. I personally know a number of patients whose only abnormal study was the ejection fraction on the HIDA scan.
Thyroid imaging is about as far as I’m probably going to get and I just want to skim over it and reiterate the indications. Evaluation of the etiology of hyperthyroidism and planning therapy for hyperthyroidism. Basically what we want to before we give anybody radioactive iodine is we want to be sure that they don’t have subacute thyroiditis. A completely reversible process and the only test that you can do for that is a radioactive iodine uptake. Evaluation of thyroid nodules or goiter or neck mass and, again, what you are doing here basically is ruling out malignancy. That’s always a key issue if you are at all tuned into the legal ramifications of what we do.

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