Reliability of biopsy-based diagnostic tests for Helicobacter pylori after treatment aimed at its eradication.
OBJECTIVE
Recurrence of Heliobacter pylori after apparently successful treatment mostly represents resurgence of the infection, rather than a new one. Therefore, the reliability of biopsy-based tests after treatment was investigated.


METHODS
Four weeks or more after treatment, antral biopsy samples were taken for culture, histology, urease test and polymerase chain reaction (PCR), and a corpus specimen for culture. Treatment failure was defined as > or = 2 tests positive. If one test was positive, a 13C-urea breath test was performed and considered conclusive.


RESULTS
One hundred and ninety-seven patients were evaluated. Endoscopy was performed 53 days (27-92 days) after treatment. Twenty-one patients with missing test results and 19 patients on acid-suppressive drugs were excluded. In 140 of 156 patients (89.7%), H. pylori was eradicated. Sensitivity and specificity of culture of antrum were, respectively, 100% and 100%; culture of corpus, 100% and 100%; rapid urease test, 87% and 99%; haematoxylin/eosin stain, 94% and 95%; Giemsa stain, 81% and 99%; and PCR, 88% and 100%.


CONCLUSIONS
Although all biopsy-based tests are reliable after treatment, culture is the biopsy-based test of first choice as it is the most accurate and gives additional information on antibiotic resistance.
van der Wouden
E J
EJ
Department of Internal Medicine, Bethesda Hospital, Hoogeveen, The Netherlands.
Thijs
J C
JC
van Zwet
A A
AA
Oey
H B
HB
Kleibeuker
J H
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D001944:Breath Tests; D016099:Endoscopy, Gastrointestinal; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000382:microbiology* / Q000473:pathology*; D016480:Helicobacter pylori / Q000201:enzymology / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011706:Pyloric Antrum / Q000382:microbiology / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014510:Urease / Q000378:metabolism
D014510:Urease