Human plasma is directly bacteriocidal against Helicobacter pylori in vitro, potentially explaining the decreased detection of Helicobacter pylori during acute upper GI bleeding.
BACKGROUND
The rapid urease test is the preferred method for detection of H pylori in patients with uncomplicated ulcer disease undergoing EGD. However, the sensitivity of this test when performed during upper GI bleeding has been questioned. It has been suggested that false-negative results occur, resulting from buffering effects of blood. The direct effect of blood was evaluated on H pylori growth in ex vivo and in vitro systems.


METHODS
Antral biopsy specimens obtained from 100 consecutive patients undergoing EGD were cultured with and without autologous blood, and RUT results at 5, 15, and 30 minutes were compared. In addition, H pylori bacterial cultures of a virulent laboratory strain were incubated with blood or blood components from 5 patients who were H pylori positive and 5 who were H pylori negative. The effect of blood on H pylori growth was determined by rapid urease test and direct bacterial plating with colony-forming unit determination.


RESULTS
Three hundred antral biopsy specimens from 100 patients were divided into 900 fragments for rapid urease test evaluation. There was no statistical difference in rapid urease test results for biopsy fragments tested immediately, cultured in blood, or cultured in phosphate-buffered saline solution. In contrast, in vitro studies demonstrated that whole blood and plasma effectively killed H pylori, whereas neutrophils and mononuclear cells had no detrimental effect on H pylori growth.


CONCLUSIONS
Human plasma contains factors that kill H pylori in vitro. This may be a possible explanation for the lower-than-expected rapid urease test detection of H pylori during active upper GI bleeding.
Houghton
JeanMarie
J
Department of Medicine, the Division of Gastroenterology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
Ramamoorthy
Ravishankar
R
Pandya
Himanshu
H
Dhirmalani
Rajesh
R
Kim
Kyung H
KH
D000208:Acute Disease; D001706:Biopsy; D001770:Blood Bactericidal Activity; D002478:Cells, Cultured; D018920:Coculture Techniques; D015169:Colony Count, Microbial; D003470:Culture Media; D005753:Gastric Mucosa / Q000382:microbiology; D006471:Gastrointestinal Hemorrhage / Q000382:microbiology*; D016481:Helicobacter Infections / Q000175:diagnosis; D016480:Helicobacter pylori / Q000201:enzymology / Q000254:growth & development* / Q000302:isolation & purification; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000502:physiology; D009504:Neutrophils / Q000502:physiology; D012680:Sensitivity and Specificity; D014510:Urease / Q000032:analysis
D003470:Culture Media; D014510:Urease