title: Accuracy of diagnostic tests for Helicobacter pylori in patients with peptic ulcer bleeding.
abstract: OBJECTIVE
  To assess the validity of biopsy-based tests (histology, culture, and urease test) and serology in detecting current H. pylori infection for the peptic ulcer patients who had gastric bleeding.
  
  
  METHODS
  A total of 398 peptic ulcer patients were enrolled and divided into two groups, according to the presence or absence of bleeding. The diagnosis for current H. pylori infection was verified using the gold standard combining individual H. pylori tests. Sensitivity, specificity, and positive and negative predictive values of the culture, Campylobacter-like organism (CLO) test (urease test), histology, and serology were compared.
  
  
  RESULTS
  Of the total study population (N = 398), 157 (39.4%) patients were categorized into the bleeding group. The sensitivities of the culture (40.0%) and CLO (85.0%) in the bleeding group were significantly lower than culture (58.1%) and CLO (96.4%) in the nonbleeding group (p = .012 and p < .001, respectively). In the bleeding group, the sensitivity of CLO (85.0%) was significantly lower than histology (92.5%) and serology (97.4%) (p = .013 and p = .002, respectively), which was not found in the nonbleeding group. The specificity of serology in the bleeding group (56.3%) was significantly lower than that of nonbleeding group (74.2%) (p = .038). Similarly, the specificity of serology was significantly lower than the other H. pylori tests in the bleeders.
  
  
  CONCLUSIONS
  Bleeding decreased the sensitivity of H. pylori tests in patients with peptic ulcer, especially in urease test or culture. In contrast, histology was found to be a quite reliable test, regardless of the presence of bleeding.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yoon J
authors.initials: YJ
authors.lastname: Choi
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Jihwan
authors.initials: J
authors.lastname: Lim
authors.forename: So Y
authors.initials: SY
authors.lastname: Jo
authors.forename: Cheol M
authors.initials: CM
authors.lastname: Shin
authors.forename: Hye S
authors.initials: HS
authors.lastname: Lee
authors.forename: Sang H
authors.initials: SH
authors.lastname: Lee
authors.forename: Young S
authors.initials: YS
authors.lastname: Park
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jin-Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Sook-Hyang
authors.initials: SH
authors.lastname: Jeong
authors.forename: Dong H
authors.initials: DH
authors.lastname: Lee
authors.forename: Hyun C
authors.initials: HC
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000032:analysis; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000737:chemistry / Q000201:enzymology / Q000302:isolation & purification*; D006652:Histological Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D012698:Serologic Tests / Q000379:methods*; D014510:Urease / Q000032:analysis
chemical_list: D001426:Bacterial Proteins; D014510:Urease