Usefulness of a delayed test for the diagnosis of Helicobacter pylori infection in bleeding peptic ulcer.
OBJECTIVE
To evaluate (i) the diagnostic usefulness of a delayed test in initially negative patients; and (ii) the reliability of the rapid urease test, histology or a combination of the two to diagnose Helicobacter pylori during emergency endoscopy in a large clinical practice series.


METHODS
Records of patients with ulcer bleeding from 1995 to 2000 were reviewed. Patients with initially negative tests were retested 4-8 weeks after the bleeding episode. Sensitivity of urease, histology or a combination of the two to detect H. pylori at initial endoscopy and the efficacy of delayed Urea Breath Test in detecting missed infection was determined.


RESULTS
The study included 429 patients. A delayed second test detected H. pylori infection in 57 out of 72 (79%) of initially negative patients. The sensitivity for detecting H. pylori was 76%, 78% and 86% for urease, histology and their combination, respectively. The prevalence of H. pylori was 95% in duodenal and 88% in gastric ulcer. In addition, only one test was performed in 17 of the 32 patients who were considered negative.


CONCLUSIONS
Not even the combination of a negative urease and histology in the initial endoscopy is able to rule out infection in bleeding ulcer patients. A delayed test should be performed to rule out Helicobacter pylori infection completely.
Güell
M
M
Unitat de Malalties Digestives, Corporacio Parc Tauli, Institut Universitari Parc Tauli, Parc Tauli s/n, Sabadell, Spain.
Artigau
E
E
Esteve
V
V
Sánchez-Delgado
J
J
Junquera
F
F
Calvet
X
X
D000328:Adult; D000368:Aged; D001706:Biopsy; D001944:Breath Tests / Q000379:methods*; D004381:Duodenal Ulcer / Q000150:complications*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013276:Stomach Ulcer / Q000150:complications*; D013997:Time Factors; D014510:Urease
D014510:Urease