title: Comparison of three methods based on endoscopic gastric biopsies for diagnosis of Helicobacter pylori active infection in a clinical setting.
abstract: BACKGROUND
  The correct diagnosis and effective treatment of Helicobacter pylori gastric infection are essential in controlling this infection.
  
  
  OBJECTIVE
  To compare the diagnostic value of three tests based in endoscopic gastric biopsies histopathological evaluation with hematoxylin-eosin (H-E) staining, urease rapid test and microbiological culture for detecting Helicobacter pylori active infection, in order to make recommendations for daily clinical practice.
  
  
  METHODS
  Gastric biopsies from 115 adult patients (85 female/30 male) were obtained by upper gastrointestinal endoscopy and studied by histopathological evaluation with H-E (antrum-corpus), urease test in 2 hours (antrum) and microbiological culture (antrum).
  
  
  RESULTS
  Helicobacter pylori active infection was diagnosed in 67% of patients. Helicobacter pylori active infection was detected by histopathological evaluation with H-E, urease test and microbiological culture in 87%, 79% and 70% of the positive cases, respectively. There were significant differences when histopathological evaluation with H-E and urease test rapid test when compared with microbiological test (P<0.01). There was no significant difference between histopathological evaluation with H-E and urease test (P = 0.7). The kappa index of agreement for histopathological evaluation with H-E/urease test was 0.56, histopathological evaluation with H-E/microbiological culture 0.6, and urease test/microbiological culture 0.64.
  
  
  CONCLUSIONS
  In a hospital setting like the one studied, histopathological evaluation with H-E and urease test are the most recommended tests for diagnosis of Helicobacter pylori active infection based in endoscopic biopsies. If pathological information of gastric lesions will be required, histopathological evaluation with H-E is essential. Urease test is mandatory if a prompt diagnosis is necessary. Microbiological culture can be used in cases of persistent or complicated infection, which may require studies on Helicobacter virulence or antimicrobial susceptibility. Selected cases might demand a combination of several tests. The three tests exhibit a good concordance level for Helicobacter pylori active infection diagnosis.
authors.affiliation: Laboratorio de Investigaciones Gastrointestinales, Instituto de Investigaciones Biológicas, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela. gabrielarismendi@gmail.com
authors.forename: Gabriel
authors.initials: G
authors.lastname: Arismendi-Morillo
authors.forename: Ileana
authors.initials: I
authors.lastname: Hernández
authors.forename: Edgardo
authors.initials: E
authors.lastname: Mengual
authors.forename: Alisbeth
authors.initials: A
authors.lastname: Fuenmayor
authors.forename: Gisela
authors.initials: G
authors.lastname: Romero
authors.forename: Maribel
authors.initials: M
authors.lastname: Lizarzábal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000254:growth & development / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000382:microbiology; D012680:Sensitivity and Specificity; D014510:Urease; D055815:Young Adult
chemical_list: D014510:Urease