Combined antrum and corpus biopsy protocol improves Helicobacter pylori culture success

Abstract

BACKGROUND Helicobacter pylori ( H. pylori ) causes chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. Eradication rates have fallen, mainly due to antimicrobial resistance. Consensus guidelines recommend that first-line treatment is based on the local prevalence of antimicrobial resistance and that rescue therapies are guided by antimicrobial susceptibility testing (AST). However, H. pylori culture is challenging and culture-based AST is not routinely performed in the majority of hospitals. Optimisation of H. pylori culture from clinical specimens will enable more widespread AST to determine the most appropriate antimicrobials for H. pylori eradication. AIM To determine whether dual antrum and corpus biopsy sampling is superior to single antrum biopsy sampling for H. pylori culture. METHODS The study received ethical approval from the joint research ethics committee of Tallaght University Hospital and St. James’s Hospital. Patients referred for upper gastrointestinal endoscopy were invited to participate. Biopsies were collected in tubes containing Dent’s transport medium and patient demographics were recorded. Biopsies were used to inoculate Colombia blood agar plates. Plates were incubated under microaerobic conditions and evaluated for the presence of H. pylori. Statistical analyses were performed using Graphpad PRISM. Continuous variables were compared using the two-tailed independent t -test. Categorical variables were compared using the two-tailed Fisher exact test. In all cases, a P value less than 0.05 was considered significant. RESULTS In all, samples from 219 H. pylori -infected patients were analysed in the study. The mean age of recruited patients was 48 ± 14.9 years and 50.7% ( n = 111) were male. The most common endoscopic finding was gastritis (58.9%; n = 129). Gastric ulcer was diagnosed in 4.6% ( n = 10) of patients, while duodenal ulcer was diagnosed in 2.7% ( n = 6). Single antrum biopsies were collected from 73 patients, whereas combined antrum and corpus biopsies were collected from 146 patients. There was no significant difference in age, sex or endoscopic findings between the two groups. H. pylori was successfully cultured in a significantly higher number of cases when combined antrum and corpus biopsies were used compared to a single antrum biopsy [64.4% ( n = 94/146) vs 49.3% (36/73); P = 0.04)]. CONCLUSION Combined corpus and antr...

Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry

“…We conclude from our findings to take at least two biopsies in the antrum and corpus for culture if H. pylori infection is macroscopically suspected (e.g. antral nodularity, peptic lesions) or after failed therapy to improve the success rate for culture [24] and to decrease the risk of missing resistant strains. The recent guidelines recommend obtaining d Adjusted odds ratios (OR adj ) with 95% confidence intervals (95% CI) obtained from the multivariable logistic regression adjusted with gender, age in years and country of living e Country distribution was given in supplementary file 2 f MET-S/CLA-S: Strains susceptible to both metronidazole and clarithromycin.…”

“…We conclude from our findings to take at least two biopsies in the antrum and corpus for culture if H. pylori infection is macroscopically suspected (e.g. antral nodularity, peptic lesions) or after failed therapy to improve the success rate for culture [ 24 ] and to decrease the risk of missing resistant strains. The recent guidelines recommend obtaining at least six gastric biopsies, thereof four for histopathology and the remaining two for culture and rapid urase test [ 8 ].…”

The second Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of Helicobacter pylori infection in adult patients in Ireland

“…Dedicated biopsies should be taken from both the antrum and the corpus to increase culture success [ 55 ]. This recommendation has been supported locally by a study carried out at Tallaght University Hospital showing that H. pylori was successfully cultured in a significantly higher number of cases when combined antrum and corpus biopsy sampling was used compared with a single antrum biopsy [64.4% (n = 94/146) vs. 49.3% (36/73); P = 0.04)] [ 56 ]. In support of a combined biopsy protocol, differences in the antimicrobial susceptibility profiles of H. pylori isolated from the corpus compared with the antrum have been reported [ 57 , 58 ].…”