July 24, 2012

OSCE pro III series 26

Notes: Modified from OSCE Professional III 2004, station 23. Other kit for this method is called as Pronto test which having similar principles with CLO test.


1)What is the name of the test that use above kit? (2m)
2)Outline the steps to use the test? (2m)
3)What is the principle of the above test (1m)
4)How to interpreted the test (1m)
5)3 other test to confirm the organism
6)How do you manage the patient with positive results? (4m)


1)Rapid urease test


a)Peel back the adhesive cover

b)Place one or more biopsy specimen on the test yellow dote, reseal and press the label over the dot with your finger to squeeze the tissue juice out of specimen.

c)Monitor the result after one minute and up to 60 minutes

3)The basis of the test is the ability of H. pylori to secrete the urease enzyme, which catalyzes the conversion of urea to ammonia and bicarbonate. The alkali product then reacts with the chemical substrate in the test kit and produce positive result.

4)Interpretation of the test

a)Positive result may indicate the presence of H. pylori organism

5)Confirmation of H. pylori

-Gram stain and microscopy of biopsy

-Culture of biopsy

-Serological test for IgG antibody to H. pylori

-Urease breath test (not available in USM)

6)Management of H. pylori induced peptic ulcer disease

a)Giving the triple therapy for one to two weeks consisting of 2 antibiotics and one proton pump inhibitors, for examples

-Tablet Omeprazole 0.8 mg/kg daily (approximately 40 mg In adult)
-Tablet Metronidazole 8mg/kg tds (approximately 400 mg in adult)
-Tablet amoxicillin 10mg/kg tds (approximately 500 mg in adults)
-Or, Metronidazole can be replaced with tab clarithromycin 7.5-15 mg/kg bds.

b)If the triple therapy fails to eradicate the H. pylori, may use quadruple therapy
Omeprazole + Bismuth subsalicylte + Tab. Tetracycline + Metronidazole
c)Withdrawal of any offensive drugs like NSAIDs
d)May add drug for mucosal protective barrier like Sucralfate or antacids like MMT.

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