Rapid urease test is less sensitive than histology in diagnosing Helicobacter pylori infection in patients with non-variceal upper gastrointestinal bleeding.
OBJECTIVE
The validity of the rapid urease (CLO) test to diagnose Helicobacter pylori infection in patients with bleeding ulcers has been questioned. The aim of this paper is to evaluate the validity of the CLO test in comparison with histology in diagnosing H. pylori infection in patients with acute upper gastrointestinal bleeding (UGB), irrespective of non-steroidal anti-inflammatory drug (NSAID) use.


METHODS
Upper gastrointestinal endoscopy was performed within 24 h of admission for all patients with UGB admitted to the Department of Pathophysiology, Medical School, Athens, for a period of 12 months. Patients with variceal bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication therapy were excluded from the study. At least four biopsies (two from the antrum and two from the body) were obtained for the CLO test and histology (modified Giemsa).


RESULTS
Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 women) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, while 44 patients (61%) were found to be positive on histology (P<0.045, 95% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 68 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not influence results of either the CLO or histology.


CONCLUSIONS
The CLO test, performed within 24 h of hospital admission in patients with UGB, irrespective of NSAID use, is unreliable for the detection of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results.
Archimandritis
A
A
Department of Pathophysiology, University of Athens Medical School, Greece. aarchim@cc.uoa.gr
Tzivras
M
M
Sougioultzis
S
S
Papaparaskevas
I
I
Apostolopoulos
P
P
Avlami
A
A
Davaris
P S
PS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001706:Biopsy; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis; D016145:Endoscopy, Digestive System; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000201:enzymology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis; D014510:Urease / Q000032:analysis*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D014510:Urease