title: Cardiac biopsy of stomach may improve the detection of H. pylori after dual therapy.
abstract: OBJECTIVE
  To determine whether gastric cardia biopsy may improve the detection of Helicobacter pylori (H. pylori) before and after eradication therapy.
  
  
  METHODS
  A total of 150 dyspeptic patients with H. pylori infection completing a 2-week course of dual therapy (amoxicillin plus omeprazole) were studied. Endoscopy was carried out at the initial stage and 4 weeks after the completion of dual therapy. During each endoscopy, gastric biopsies were sampled in order from cardia, lower body, and antrum and stored separately to survey the distribution of H. pylori by histology.
  
  
  RESULTS
  Before treatment, 88% (132/150) of the study cases had H. pylori found in antrum and 3.3% (5/150) of cases presented with bacteria only in cardia. After treatment, 38 cases had failure of dual therapy. The detection rates of H. pylori by biopsies without cardia decreased after the dual therapy (by antrum only: 88% to 60.5%, p < 0.05; antrum and body: 96.7% to 81.6%, p < 0.05). In contrast, the incidence of patients with only cardia involvement by H. pylori significantly increased from 3.3% (5/150) before to 18.4% (7/38) after treatment (p < 0.01). Among the 7 patients with H. pylori only in cardia after dual therapy, 3 cases had recurrent dyspepsia during follow-up because of no further anti-H. pylori therapy. Two of these 3 cases disclosed diffuse bacterial involvement in antrum and body besides cardia; the last case later had a positive result of urea breath test.
  
  
  CONCLUSIONS
  Biopsy obtained from gastric cardia can improve the detection rate of H. pylori especially after dual therapy, which encounters antibiotics with possible sanctuary sites here. Thus, it will be useful to prevent over diagnosis of H. pylori eradication.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. Linxz@mail.ncku.edu.tw
authors.forename: B S
authors.initials: BS
authors.lastname: Sheu
authors.forename: X Z
authors.initials: XZ
authors.lastname: Lin
authors.forename: H B
authors.initials: HB
authors.lastname: Yang
authors.forename: C H
authors.initials: CH
authors.lastname: Chien
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001706:Biopsy; D002299:Cardia / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D011446:Prospective Studies; D013270:Stomach / Q000382:microbiology* / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D010406:Penicillins; D000658:Amoxicillin; D009853:Omeprazole