V GI - V LABORATORY DISEASE RobertL.Fitzgerald,Ph.D...

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LABORATORY  TESTS OF GASTROINTESTINAL  DISEASE  Laboratory Medicine (SPPS 216) Robert L. Fitzgerald, Ph.D. Clinical Professor of Pathology [email protected] 858-552-8585 x 7761 Wiki (ucsdlabmed.wikidot.com)
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OBJECTIVES Describe laboratory tests used to diagnose  malabsorption and maldigestion Describe how to interpret various  laboratory tests for  Helicobacter Pylori Describe the Schilling test for vitamin B 12   absorption Describe the tests for diagnosis of Celiac  disease Describe the sweat test for cystic fibrosis
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KEY TERMS  Achlorhydria Celiac Disease Cystic Fibrosis GERD Zollinger-Ellison (Z-E)  Syndrome
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BACKGROUND/SIGNIFICANCE  The GI tract is a vast and diverse system  subject to a plethora of disorders Many laboratory tests are invaluable tools  used to diagnose and manage these  disorders Drug therapy is well established for the  treatment of many diseases of the GI tract Essential for pharmacists to understand  interpretation of laboratory tests for  recommending appropriate medications 
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GERD The most common disorder in the  esophagus It affects up to 10% of the population The commonly used laboratory test is  based on the measurement of the amount  of HCl produced by the stomach
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GERD Gastric Function Tests Measurement of the amount of HCl produced  by the stomach under basal and fasting  conditions, followed by testing after maximal  stimulation 
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GERD Standard methods now in use: Basal gastric secretion  Pentagastrin stimulation test  Gastric Acid Young people > Old people Gastric carcinoma < Controls Men > Women Gastric ulcer < Controls Duodenal ulcer > Controls
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GERD Gastric Disorders  vs.  Gastric acid  secretion  Disorder Gastric acid secretion Zollinger-Ellison syndrome greatly Hypersecretion of gastrin by antral G-cells greatly Pernicious anemia Post vagotomy Chronic renal failure variable
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GERD Drugs Important in Hyperacidity H 2  antagonists ( e.g. , cimetidine, ranitidine) Inhibit gastric acid secretion due to histamine  stimulation Proton-pump inhibitors ( e.g. , lansoprazole,  omeprazole) Irreversibly inhibit pump that produces H +  (H  + -K  +   ATPase) Little effect on intrinsic factor, pepsin or overall volume  of secretion Antacids ( e.g. , Mg(OH) 3 , Al(OH) 3 , CaCO 3 ) Neutralize HCl
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Helicobacter Pylori Diagnostic tests Biopsy Culture Detection of urease enzyme activity 13 C-breath test
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