Helicobacter Pylori Differential Diagnosis Table

Helicobacter pylori is also known as H. pylori, which is actually the name of a bacterium that resides in the stomach and damages the inner lining of the stomach as well as the outer part of the duodenum. This bacterium adapts to live in the harsh and acidic environment of the stomach. H. pylori is also responsible for ulcers in the stomach and duodenum. At first, this infection looks like inflammation and soreness, but soon develops into an ulcer.

According to research by Meta Analysis 2018, around 44% of the world population is infected with this bacterium. These bacteria are spiral in shape, allowing them to penetrate the lining of the stomach and hide in the mucus where the body’s immune cells can’t reach them. This is why these bacteria survive in the stomach, and this is where the stomach diseases begin.

Most people with this disease have no symptoms in the early stages until inflammation develops into a peptic ulcer. The common symptom of the ulcer is bloating, stomach cramps, abdominal pain, etc.

Fortunately, this disease is treatable. If you have experienced the above symptoms, seek urgent medical attention as Helicobacter pylori can cause ulcers in the stomach. An experienced doctor will perform some tests to determine the presence of Helicobacter pylori and then prescribe the triple therapy drugs to counter Helicobacter pylori and treat the stomach ulcer.

Helicobacter Pylori Differential Diagnosis Table:

Helicobacter pylori, most commonly known as H. pylori, is a common bacterial infection that affects most of the population worldwide. The infection mainly affects the stomach and the first part of the small intestine, causing inflammation that leads to gastritis and peptic ulcers.
The most common cause of H.pylori is said to be food conatmination, spread from one person to another is very common through saliva secretion (By kissing.)
The most common cause of H. pylori is said to be food contamination, spread from one person to another is very common through saliva secretion (by kissing). H. pylori can affect a lot of people without any symptoms; usually, a person won’t know that they are infected except with long-term symptoms of gastritis like stomach pain, nausea, and vomiting.

How to Distinguish Helicobacter Pylori from Other Diseases

Distinguish Peptic Ulcer from Helicobacter Pylori – Diagnosis

Peptic ulcers are sores inside the lining of your stomach; peptic ulcers often cause similar symptoms to H. pylori, like nausea, vomiting, and stomach pain. In severe conditions, the pain reflects to the back, and vomiting of blood may occur. Peptic ulcers may be caused by H. pylori itself or from medication like NSAIDs or from stress.

• Endoscopy is usually the gold standard test for the diagnosis of peptic ulcers, where the doctor inserts a tube with a camera inside your stomach to see ulcers.
• It’s important to perform H. pylori tests like the urea breath test and stool test to know if the peptic ulcer is caused by it or not.
• Upper gastrointestinal series, which is a series of x-rays with barium contrast that gives clear images of ulcers.

“It’s important to know the patient’s history to know the cause of the peptic ulcer to prevent recurrence after treatment.”

Distinguish Gastritis from Helicobacter Pylori – Diagnosis

Gastritis is an inflammation of the mucous lining of the stomach that protects it; almost everyone has experienced gastritis before. It has many causes: bacteria, drugs, chemicals, food, or alcohol, and it can be acute or chronic too. Most cases of gastritis are self-limited, but if the condition has lasted for more than one week, it may be from a serious condition.

• Upper GIT endoscopy can help in the diagnosis and ruling out of ulcers as a cause, but during endoscopy, a biopsy can be taken to confirm the diagnosis.

“Other tests like blood or stool tests should be done to exclude H. pylori and other causes that can have caused gastritis.”

Distinguish Gastroesophageal Reflux Disease from Helicobacter Pylori – Diagnosis

Gastroesophageal reflux (GERD) is a severe form of acid reflux that happens after the ingestion of large meals mainly. The stomach refluxes its content to the esophagus, causing heartburn and regurgitation. GERD is caused by a defect in the lower esophageal sphincter that prevents food from coming back up after ingestion. When this sphincter doesn’t close completely, the food can move up to the esophagus, causing GERD.

• Reflux testing helps doctors monitor your reflux over a specific period of time. It has two ways: either through the insertion of a chip or a catheter into your esophagus. This will help the doctor detect any abnormality.
• Upper endoscopy can help in diagnosing any abnormality in the esophagus and ruling out any serious complications that may occur or conditions that may look like GERD.
• Esophageal manometry helps in monitoring muscle contraction during feeding, but this is usually needed in patients who have trouble swallowing.

Distinguish Dyspepsia Disease from Helicobacter Pylori – Diagnosis

Dyspepsia, commonly known as indigestion, is the feeling of having a full stomach directly after eating or drinking. It may cause stomach pain and bloating too. It’s rather a symptom more than a disease; it can be a symptom of GERD or maybe other conditions.
Since dyspepsia is not a condition itself, its diagnosis depends mainly on knowing the underlying condition:

• Urea breath test and stool test to rule out or confirm H. pylori.
• Upper GI endoscopy is needed if indigestion is severe to check for ulcers or GERD.
• An X-ray can be done to check if the cause of dyspepsia is intestinal obstruction.

Distinguish Irritable Bowel Syndrome Disease from Helicobacter Pylori – Diagnosis

Irritable bowel syndrome (IBS) is a gastrointestinal disorder that causes stomach pain with either diarrhea or constipation. It’s a chronic condition with no cure, and the exact cause of IBS is unknown but it may be linked to increased stress.
There’s no definitive diagnostic test for IBS; a lot of tests will be done to rule out other conditions and confirm the diagnosis.

• Colonoscopy to rule out the presence of polyps on the colon that can cause similar symptoms.
• Stool test to see if there’s an infection that is causing these symptoms.
• X-ray to check for any abnormalities in the abdomen and colon.
• Use of ROME criteria, which are diagnostic criteria that help in identifying IBS.

Distinguish Inflammatory Bowel Disease from Helicobacter Pylori – Diagnosis

Inflammatory bowel disease (IBD) is a condition that describes two diseases: Crohn’s disease and ulcerative colitis. The two diseases vary in the location where they cause inflammation in the GIT, but they both cause symptoms of abdominal pain and diarrhea. The severity of the condition can vary greatly from mild symptoms to life-threatening.
Diagnostic procedures for IBD can be different according to whether it’s Crohn’s disease or ulcerative colitis.

• If ulcerative colitis is suspected, a colonoscopy is used to see the extent of inflammation in the colon.
• If Crohn’s is suspected, a capsule endoscope is needed to examine the small intestine and see inflammation. It is a process where the patient ingests a capsule with a camera to examine the small intestine.
• X-ray, CT, and MRI can be used in severe symptoms to see if any complications from the disease itself have happened, like a perforated megacolon or a fistula that has developed.

“Stool test is sometimes needed to rule out the presence of a parasite or an infection that is causing the disease.”

Distinguish Celiac Disease from Helicobacter Pylori – Diagnosis

Celiac disease is a genetic autoimmune disorder. When the patient eats food with gluten in it (which is a kind of protein), this triggers the body to cause an immune response, causing inflammation in the small intestine and symptoms of abdominal pain and bloating. This disease appears from childhood, and if left untreated, can lead to malabsorption in children.
The doctor will order diagnostic tests after suspecting the disease from your symptoms or finding abnormal anemia in blood tests that can’t be explained.

• Serology blood test to detect the presence of antibodies in your blood.
• Upper endoscope with the taking of a biopsy in the small intestine; a biopsy is diagnostic for celiac disease.
• A gluten challenge test, where the patient ingests food containing gluten and waits for symptoms to appear.

“It’s important before any diagnostic test for celiac disease that the patient doesn’t try a gluten-free diet so the signs and symptoms can appear during diagnosis.”

Distinguish Gastric Cancer from Helicobacter Pylori – Diagnosis

Gastric cancer is a form of cancer that develops in the stomach, mainly in the lining of the stomach. Most types of gastric cancer are adenocarcinoma. The prognosis of gastric cancer may be good if caught early and hasn’t yet metastasized to other parts of the body.

• An endoscopy is the first step in the diagnosis of gastric cancer. If the doctor sees any abnormalities in the tissue of the stomach, they will take a biopsy to confirm the diagnosis.
• Imaging tests like CT scan, MRI, and PET scan will be needed if the diagnosis is confirmed to know the exact extent of the tumor and if it has reached the lymph nodes or any other organs.

Distinguish Non-Hodgkin Lymphoma from Helicobacter Pylori – Diagnosis

Non-Hodgkin lymphoma (NHL) is a type of cancer that affects lymphocytes in the body that help protect against infection. There’s a type of lymphoma called MALT lymphoma, which is a less aggressive form of lymphoma that most of the time is localized at a specific organ; commonly affects the stomach and is known as Gastric MALT Lymphoma. Symptoms may include heartburn and weight loss.

• A lymph node biopsy with immunophenotyping is the gold standard diagnostic test for the diagnosis of NHL and its subtype MALT lymphoma.
• Imaging tests like CT scan and PET scan are needed if the diagnosis is confirmed to know the extent of malignancy.

Distinguish Gastrinoma from Helicobacter Pylori – Diagnosis

Gastrinomas are pancreatic endocrine tumors that affect most of the time either the pancreas or duodenum, causing increased secretion of gastrin. This leads to symptoms of heartburn and peptic ulcer. Most gastrinomas are diagnosed very late, which can lead to a very bad prognosis.

• The gold standard test for Gastrinoma is to measure gastrin levels; if they are more than > 1000 pg/mL (> 480 pmol/L), this would confirm the diagnosis.
• In case gastrinoma is suspected but gastrin levels are low, a secretin challenge test can be done, where a dose of secretin is injected, and later on, gastrin is measured; if high, that can confirm the diagnosis.

“Initial diagnosis of gastrinoma mainly depends on the patient’s history to know if there’s a recurrence of symptoms and non-response to treatment.”

Distinguish Zollinger-Ellison Syndrome from Helicobacter Pylori – Diagnosis

Zollinger-Ellison Syndrome is not a disease itself but rather a clinical manifestation of symptoms that happen due to a tumor-like gastrinoma. It’s a combination of heartburn due to too much gastric acid that can cause peptic ulcer, along with diarrhea.
Diagnostic tests for the syndrome are mainly the same as the disease causing it; gastrinoma.

• Secretin challenge test and gastrin levels can help diagnose gastrinoma, therefore confirming Zollinger-Ellison syndrome.
• Upper GIT endoscopy is used to check erosion of the esophagus and inflammation.

Important Red Flags in Helicobacter Pylori

H. pylori is a very common disease and it has very definitive diagnostic tests, though it’s important to know that before diagnostic tests, the patient must not take any treatment or PPI because that can cause false negative results.
A very rare symptom in H. pylori is dyspepsia; it can happen to some patients but due to the possibility that it may be an indication of an underlying condition, an endoscope may be required to rule that out.
The probability of developing gastric cancer or Malt lymphoma from H. pylori is very low, but it exists, so treatment is important even if symptoms are mild.

Our Additional Resources:

About our project:

Other useful videos about helicobacter pylori: