Helicobacter pylori prevalence is decreasing globally and prevalence of non H. pylori gastric ulcers is increasing. The following study was conducted to assess the prevalence of H. pylori in benign gastric ulcers in a sample of Sri Lankan patients. This was a cross-sectional study of 59 dyspeptic patients with benign gastric ulcers. Multiple endoscopic gastric biopsies were obtained and histology, immunohistochemistry and polymerase chain reaction were performed for H. pylori detection. An immunochromatography assay was performed to detect blood anti H. pylori antibodies. Four (6.8%) were positive for H. pylori. Therefore, it is likely that most benign gastric ulcers are of non-H. pylori aetiology.
The aim of the study was to evaluate the suitability of a modified one minute rapid urease test (one day rapid urease test) as a low cost H. pylori detection method. A sample of 205 patients clinically suspected of having H. pylori infection was tested. One day rapid urease test and histology based H. pylori tests (the gold standard) were performed on endoscopic antral biopsies. There were 6 true positives, 191 true negatives, 8 false positives and zero false negatives. The sensitivity, specificity and positive (PPV) and negative predictive values (NPV) of the test were 100%, 96%, 42.9%, and 100% respectively. The cost per patient was 0.3US$. High sensitivity, specificity and NPV, low cost and simplicity of method were the advantages of the test and the main limitation was low PPV. Hence, one day rapid urease test can be considered as a suitable low cost method to detect H. pylori infection in resource limited settings.
Helicobacter pylori is regarded as a common cause of gastritis and peptic ulcer disease. The most commonly used H. pylori detection method in Sri Lanka is histology. However, the detection rate of H. pylori in routine histology practice is low. Therefore, we conducted the following study to evaluate the diagnostic efficacy of histology and to analyze the possible problems associated with H. pylori detection. Multiple endoscopic gastric biopsies were obtained from a sample of 205 patients detected to have endoscopic gastric erythema or ulcers. Biopsies were formalin fixed and paraffin embedded and stained with haematoxylin and eosin, toluidine blue and immunohistochemistry. Serum was collected for screening of anti H. pylori antibodies using an immunochromatography based kit method. Diagnostic efficacy of histology was evaluated against immunohistochemistry as the gold standard. Inter observer variation among four pathologists was assessed using the intraclass correlation coefficient. Haematoxylin and eosin showed a sensitivity of 100% and specificity of 99% and toluidine blue had 100% sensitivity and 98.5% specificity. Average measures of intra class correlation coefficient for H&E was 0.428 (95% CI 0.228-0.588) and for toluidine blue stain 0.320 (95% CI 0.085-0.513). The sero prevalence of anti-H. pylori antibodies was 4.9%. In conclusion, sensitivity, specificity and negative predictive values of histology in detecting H. pylori are shown to be high. Main limitations were, low positive predictive value and unsatisfactory interobserver agreement.
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