Diagnosis and treatment of Helicobacter pylori for peptic ulcer bleeding in clinical practice - factors associated with non-diagnosis and non-treatment, and diagnostic yield in various settings

Abstract

Background/Aims: To study the practice of clinicians in the diagnosis and treatment of H. pylori for peptic ulcer bleeding, and the diagnostic yield of H. pylori tests in various situations. Materials and Methods: All consecutive patients aged ≥18 years who underwent esophagogastroduodenoscopy for the indications of coffee-grounds vomitus, hematemesis or melena with endoscopically diagnosed peptic ulcers were included. Results: 374 patients were included. H. pylori testing was performed during acute bleeding for 296 patients. 80% of patients who tested negative for H. pylori during the acute episode were planned for repeat H. pylori testing. 11/88 patients who tested negative for H. pylori during the acute episode were positive for H. pylori during repeat testing (diagnostic yield 12.5%). Prior proton-pump inhibitor and antibiotic ingestion within 4 weeks of presentation was associated with lower diagnostic yield for H. pylori. On multivariate analysis, patient's age, systolic blood pressure, heart rate, activated partial thromboplastin time, and need for endoscopic treatment were associated with failure to take biopsies for H. pylori testing during acute episode. 100/106 patients tested positive for H. pylori during the acute episode of gastrointestinal bleeding had H. pylori treatment. Conclusion: Repeat H. pylori testing after index negative H. pylori testing during acute episodes gave a diagnostic yield of 12.5%, reinforcing the importance of repeat testing.

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

“…Interestingly, no recent meta-analyses or RCTs further examining either the diagnostic performance of testing in the acute setting or the concept of re-testing after the bleeding event, have been published. Re-testing for H. pylori is further supported only by the results of a 2014 prospective cohort study including 374 patients, in which retesting provided an additional diagnostic yield of 12.5 % (11 patients newly positive during delayed testing out of 88 initially negative patients, who repeated testing either through endoscopy or urea breath testing) [175]. Nevertheless, current evidence substantively justifies both the value of H. pylori testing in the acute setting as well as the role of delayed testing in minimizing the underestimation of H. pylori prevalence in peptic ulcer hemorrhage.…”

Inflammatory Disorders Associated With Helicobacter Pylori in the Roux-en-Y Bypass Gastric Pouch

“…This requirement is based on the supposition that the existence of these bacteria is linked to ulcers or cancers of the excluded stomach after the procedure. The present study uses a number of tests to conclude its diagnosis, including the rapid urease test, histology and tissue biopsy, along with non-endoscopic tests of blood and serum 10 , 13 .…”

Prevalence of Helicobacter Pylori Infection in Patients with Upper Gastrointestinal Bleeding

“…During Oesophagio-Gastro-Duodenoscopy (OGD), there are three methods to identify the organism in a gastric biopsy specimen: rapid urease test, histology, and culture. The choice of method depends on the clinical situation, cost, and test accuracy [14]. In general, in each case, 1 or 2 biopsies should be obtained from both the antrum and corpus.…”

“…In general, in each case, 1 or 2 biopsies should be obtained from both the antrum and corpus. Guidelines propose initially using the rapid urease test because the method is efficient, relatively inexpensive, and generally accurate [14][15]. Test results are often positive within minutes to hours.…”

“…Histologic examination had been considered the gold standard for identifying infection, with reported sensitivity and specificity as high as 95% and 98%, respectively [20]. However, the distribution and density of organisms can vary within the stomach, resulting in sampling error, particularly in patients taking anti-secretory medications [14,16]. Histology is the optimal method for the detection of H. pylori associated premalignant lesions (multifocal atrophic gastritis, intestinal metaplasia, dysplasia) [16].…”