Detection of Helicobacter pylori by rapid urease test and histology: Impact of acid suppression therapy

 

Saima Javed PARACHA, Vui Heng CHONG, Anand JALIHAL

Division of Gastroenterology and Hepatology, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam

 

ABSTRACT

 

Introduction: Helicobacter pylori (H. pylori) infection is very common particularly in the developing countries. It is strongly associated with gastric ulcer diseases, chronic gastritis, gastric adenocarcinomas and mucosal associated lymphoid tissue (MALT) lymphoma. H. pylori can be detected by various invasive (rapid urease test (Pronto-dry) and Histology) and non-invasive tests (stool antigen test, urea breath tests and serology). Our aims are to assess whether biopsy or rapid urease test is superior in diagnosing H. pylori, and to study the impact of acid suppression therapies on these two tests. Material and Methods: Patients who had endoscopy at the RIPAS Hospital over a period of six months and had testing for H. pylori were included. Only patients who were tested by both histology and Pronto-dry (n = 233, mean age 45.0 ± 16.1 years, male; 57.5%) were included in the study. Positivity for H. pylori was considered when either or both tests were positive. Result: The overall positivity rate (either or both positive) for H. pylori was 38.2%. Pronto-dry (24%, n = 56) and histology (33%, n = 77). The concordant rate was 80.9% (both +ve; 18.9%, both –ve 61.8%) and disconcordant rate was 19.4% (histology +ve/ Pronto-dry –ve in 14.2% and histology –ve/ Pronto-dry +ve in 5.2%). Use of acid suppression therapy (either proton pump inhibitor [PPI] or Histamine-2-receptor antagonist [H2RA]) resulted in false negative rates of 34.1% and 15.9% respectively for Pronto-dry and histology. The false negative rates were higher for PPI (52% for Pronto-dry and 24% for histology) compared to H2RA (10.5% for Pronto-dry and 5.3% for histology) Conclusion: Both Pronto-dry and histology are associated with false negative. Use of PPI and H2RA before endoscopy reduces the sensitivity of antral and corpus biopsies for H. pylori detection with both Pronto-dry and histological examination.

 

Keywords: Helicobacter pylori, detection, acid suppression, rapid urease test, histology

  

Correspondence author: Vui Heng CHONG

Division of Gastroenterology and Hepatology, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam

Tel: +673 2242424 Ext 5233

E mail: chongvuih@yahoo.co.uk

 

Brunei Int Med J. 2014; 10 (5): 256-261

 

 

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