Comparison of three methods based on endoscopic gastric biopsies for diagnosis of Helicobacter pylori active infection in a clinical setting

Abstract

-Context -The correct diagnosis and effective treatment of Helicobacter pylori gastric infection are essential in controlling this infection. Objective -To compare the diagnostic value of three tests based in endoscopic gastric biopsies histopathological evaluation with hematoxylin-eosin (H-E) staining, urease rapid test and microbiological culture for detecting Helicobacter pylori active infection, in order to make recommendations for daily clinical practice. Methods -Gastric biopsies from 115 adult patients (85 female/30 male) were obtained by upper gastrointestinal endoscopy and studied by histopathological evaluation with H-E (antrum-corpus), urease test in 2 hours (antrum) and microbiological culture (antrum). Results -Helicobacter pylori active infection was diagnosed in 67% of patients. Helicobacter pylori active infection was detected by histopathological evaluation with H-E, urease test and microbiological culture in 87%, 79% and 70% of the positive cases, respectively. There were significant differences when histopathological evaluation with H-E and urease test rapid test when compared with microbiological test (P<0.01). There was no significant difference between histopathological evaluation with H-E and urease test (P = 0.7). The kappa index of agreement for histopathological evaluation with H-E/urease test was 0.56, histopathological evaluation with H-E/microbiological culture 0.6, and urease test/microbiological culture 0.64. Conclusions -In a hospital setting like the one studied, histopathological evaluation with H-E and urease test are the most recommended tests for diagnosis of Helicobacter pylori active infection based in endoscopic biopsies. If pathological information of gastric lesions will be required, histopathological evaluation with H-E is essential. Urease test is mandatory if a prompt diagnosis is necessary. Microbiological culture can be used in cases of persistent or complicated infection, which may require studies on Helicobacter virulence or antimicrobial susceptibility. Selected cases might demand a combination of several tests. The three tests exhibit a good concordance level for Helicobacter pylori active infection diagnosis. HEADINGS -Gastritis. Helicobacter infections. Urease. Microbiological technique.

Association ofHelicobacter pyloriwith Parkinson's Disease

“…Anti- H. pylori antibodies do not always imply the presence of an active infection, and so we may have overtreated our patients. Upper gastrointestinal endoscopy and biopsy as well as rapid urease treatment are suggested for all patients with antibody positivity,27 but most of the PD patients in our clinic refuse this procedure. The urea breath test is a noninvasive technique, but 13C radioactive ligands are not available in our state and serology still remains the most commonly performed test worldwide 28…”

Concordancia entre procedimientos diagnósticos invasivos para la infección por Helicobacter pylori en adultos

“…En estudios anteriores sobre la concordancia entre histología y la prueba rápida de la ureasa, Bermejo F y colaboradores 15 y Arismendi-Morillo G y colaboradores 16 obtuvieron una concordancia moderada (K= 0.46 y K= 0.56, respectivamente) que es similar a la de este estudio; sin embargo, Tepes B 17 y Redéen S y colabodarores 11 encontraron una concordancia casi perfecta (K= 0.81 y K= 0.86, respectivamente) y Alarcón Rivera y colaboradores 18 una concordancia buena (K= 0.62).…”

Regular arrangement of collecting venules (RAC) as an endoscopic marker for exclusion of Helicobacter pylori (H. pylori) infection: A systematic review and meta‐analysis

“…Conventional examinations for the diagnosis of H. pylori infection include non‐invasive tests such as urea breath tests, faecal antigen tests, and serological parameters, and invasive tests such as histological examination and culture 12‐17 . These examinations, however, cannot evaluate endoscopic findings associated with H. pylori infection.…”

“…histological examination and culture. [12][13][14][15][16][17] These examinations, however, cannot evaluate endoscopic findings associated with H. pylori infection. Recently, many investigators have attempted to characterise endoscopic features indicative of H. pylori infection.…”