title: The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting.
abstract: BACKGROUND
  Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting.
  
  
  METHODS
  Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and 13C-UBT tests were performed.
  
  
  RESULTS
  Seventeen patients were defined H. pylori positive by 13C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting.
  
  
  CONCLUSIONS
  In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in persistent peptic ulcer cases.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of Tartu, Estonia. Heidi-Ingrid.Maaroos@ut.ee <Heidi-Ingrid.Maaroos@ut.ee>
authors.forename: Heidi-Ingrid
authors.initials: HI
authors.lastname: Maaroos
authors.forename: Helena
authors.initials: H
authors.lastname: Andreson
authors.forename: Krista
authors.initials: K
authors.lastname: Lõivukene
authors.forename: Pirje
authors.initials: P
authors.lastname: Hütt
authors.forename: Helgi
authors.initials: H
authors.lastname: Kolk
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kull
authors.forename: Katrin
authors.initials: K
authors.lastname: Labotkin
authors.forename: Marika
authors.initials: M
authors.lastname: Mikelsaar
mesh_terms: D001431:Bacteriological Techniques; D001706:Biopsy; D001944:Breath Tests; D003938:Diagnostic Techniques, Digestive System; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori; D006652:Histological Techniques; D006801:Humans; D010437:Peptic Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016133:Polymerase Chain Reaction