A negative rapid urease test is unreliable for exclusion of Helicobacter pylori infection during acute phase of ulcer bleeding. A prospective case control study.
BACKGROUND
The reliability of the rapid urease test has not been proven in patients with peptic ulcer bleeding. Some studies show bad diagnostic results with the rapid urease test for gastrointestinal bleeding.


OBJECTIVE
To evaluate the efficacy of the rapid urease test in patients with bleeding gastric or duodenal ulcers.


METHODS
A total of 96 patients with acute peptic ulcer bleeding without proton pump inhibitor or antibiotic therapy within the last 14 days before bleeding were included into the study. During index endoscopy, specimens for histological and rapid urease test were obtained from the antrum and corpus mucosa of the stomach. Patients were also investigated by the 13C-urea breath test. Diagnostic quality parameters were calculated with the histology and the 13C-urea breath test as reference and compared with a matched control group with uncomplicated ulcers.


RESULTS
The sensitivity of the rapid urease test was 80% and the specificity 100% compared to histology and 13C-urea breath test. The negative predictive value was 75%. These values were statistically significantly different from those of the control group (sensitivity 96%, specificity 100%, negative predictive value 88%).


CONCLUSIONS
The exclusive use of the rapid urease test cannot be recommended in patients with peptic ulcer bleeding.
Schilling
D
D
Department of Internal Medicine C (Gastroenterology and Hepatology), Klinikum der Stadt Ludwigshafen, Academical Medical Hospital of the University of Mainz, Bremserstr. 79, D-67063 Ludwigshafen/Rhine, Germany. d-schilling@t-online.de
Demel
A
A
Adamek
H E
HE
Nüsse
T
T
Weidmann
E
E
Riemann
J F
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests; D016022:Case-Control Studies; D004381:Duodenal Ulcer / Q000150:complications / Q000382:microbiology*; D016145:Endoscopy, Digestive System; D005188:False Negative Reactions; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000382:microbiology / Q000473:pathology; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014508:Urea; D014510:Urease / Q000032:analysis*
D014508:Urea; D014510:Urease