Métodos diagnósticos para la detección de infección por Helicobacter pylori. ¿Cuál y cuándo deben solicitarse?
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Date
2022
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Abstract
La infección gástrica por Helicobacter pylori tiene una pre-valencia variable a nivel mundial. En Latinoamérica, puede superar el 50% de infectados. Se asocia a patologías como la úlcera péptica, el cáncer gástrico, el linfoma MALT y la púrpura trombocitopénica inmune, entre otras. No hay un método diagnóstico óptimo y la presencia puede ser detectada tanto por métodos invasivos, que requieren una endoscopía digestiva alta, como no invasivos. Dentro de los invasivos, contamos con la prueba rápida de ureasa, la histología, las pruebas moleculares, como reacción en cadena de la poli-merasa, y el cultivo. Por su parte, los no invasivos incluyen la prueba de aire espirado, el antígeno en deposiciones de Helicobacter pylori, reacción en cadena de la polimerasa en deposiciones y la serología. La prueba diagnóstica a utilizar depende del escenario clínico, y deben conocerse los beneficios y debilidades de cada método. Es importante considerar la edad del paciente, sus factores de riesgo de cáncer gástrico, la necesidad de endoscopía por esta u otra causa, la disponibili-dad de las pruebas diagnósticas y el costo, entre otros.
Gastric infection by Helicobacter pylori has a variable prevalence worldwide. In Latin America, it can exceed 50% of infected people. It is associated with peptic ulcer, gastric cancer, MALT lymphoma, immune thrombocytopenic purpura, among other pathologies. There is no optimal diagnostic method, and its presence can be detected by both invasive methods that require an upper gastrointestinal endoscopy, and non-invasive methods. Within the invasive, we have the rapid urease test, histology, molecular tests such as polymerase chain reaction and culture. On the other hand, non-invasive tests include the breath test, Helicobacter pylori antigen in stools, polymerase chain reaction in stools and serology. Depending on the clinical scenario, the diagnostic test to be used, its benefits and weaknesses should be known. It is important to consider the age of the patient, their gastric cancer risk factors, the need for endoscopy for this or another reason, the availability of diagnostic tests and the cost, among others.
Gastric infection by Helicobacter pylori has a variable prevalence worldwide. In Latin America, it can exceed 50% of infected people. It is associated with peptic ulcer, gastric cancer, MALT lymphoma, immune thrombocytopenic purpura, among other pathologies. There is no optimal diagnostic method, and its presence can be detected by both invasive methods that require an upper gastrointestinal endoscopy, and non-invasive methods. Within the invasive, we have the rapid urease test, histology, molecular tests such as polymerase chain reaction and culture. On the other hand, non-invasive tests include the breath test, Helicobacter pylori antigen in stools, polymerase chain reaction in stools and serology. Depending on the clinical scenario, the diagnostic test to be used, its benefits and weaknesses should be known. It is important to consider the age of the patient, their gastric cancer risk factors, the need for endoscopy for this or another reason, the availability of diagnostic tests and the cost, among others.
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Keywords
Diagnosis, Diagnostic tests, Helicobacter pylori, Pruebas diagnósticas, Diagnóstico