Role of rapid urease test and histopathology in the diagnosis of Helicobacter pylori infection in a developing country.
BACKGROUND
The aim of this study was to determine the effect of commonly self-prescribed proton pump inhibitors (PPI) on the results of rapid urease test and histology for the diagnosis of H. pylori infection.


METHODS
One hundred-nine consecutive patients with dyspeptic symptoms attending the endoscopy suite were enrolled in this study. Antrum biopsy specimens were collected at endoscopy for the rapid urease test (Pronto Dry, Medical Instrument Corp, France) and histopathology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and like-hood ratio of a positive and negative of Pronto Dry test were compared against histology. The gold standard test for the diagnosis of H. pylori infection was histopathology.


RESULTS
Sixty-one percent (66/109) patients were males with mean age of 43 +/- 14.1 years and age range 17-80 years. Fifty-two percent (57/109) were not on any medications while 48% (52/109) used PPI before presentation to the outpatients. Pronto Dry was positive in 40% (44/109) and negative in 60% (65/109). Histopathology was positive for H. pylori in 57% (62/109) and negative in 43% (47/109). The sensitivity, specificity, PPV, NPV and like-hood ratio of a positive and negative Pronto Dry test with and without PPI were 43.3%, 86.4%, 81.3%, 3.18, 0.656 and 52.8% vs 71.9%, 80%, 82.1%, 69%, 3.59 and 0.35.


CONCLUSIONS
This study shows that the sensitivity, specificity, NPV and PPV of rapid urease test was reduced in patients who are on PPI. The exclusive use of the rapid urease test for the diagnosis of Helicobacter pylori cannot be recommended in patients with prior PPI use.
Yakoob
Javed
J
Department of Gastroenterology and Pathology, Aga Khan University Hospital, Karachi, Pakistan. yakoobjaved@hotmail.com
Jafri
Wasim
W
Abid
Shahab
S
Jafri
Nadim
N
Abbas
Zaigham
Z
Hamid
Saeed
S
Islam
Muhammad
M
Anis
Kashif
K
Shah
Hasnain Ali
HA
Shaikh
Hizbullah
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries; D003938:Diagnostic Techniques, Digestive System; D005260:Female; D005767:Gastrointestinal Diseases / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000201:enzymology* / Q000473:pathology; D016480:Helicobacter pylori / Q000201:enzymology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D054328:Proton Pump Inhibitors; D013997:Time Factors; D014510:Urease / Q000378:metabolism*
D054328:Proton Pump Inhibitors; D014510:Urease