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Wong AS, Ching SS, Long AS
Correspondence: Dr Wong Siang Yih Andrew, firstname.lastname@example.org
INTRODUCTION The use of an additional biopsy from the gastric body may help improve the detection of Helicobacter pylori during endoscopy. This study aimed to determine whether such an additional biopsy is necessary in routine rapid urease test (RUT), and whether acid suppression and antibiotic therapy affect RUT results.
METHODS Patients recruited had two gastric mucosal biopsies taken – one from the gastric antrum and the other from the gastric body. Each biopsy was placed into separate RUT kits. Information on previous or current use of proton-pump inhibitors, H2 receptor antagonist, bismuth and antibiotics was obtained. Patients on any of those drugs one week prior to endoscopy were considered to have a positive drug history (PDH).
RESULTS Of the 400 patients recruited, 311 had negative RUTs and 89 had at least one positive RUT. Between the PDH and negative drug history (NDH) groups, there was a significant difference in the distribution of the location of the biopsies that yielded positive RUTs (p = 0.023). The NDH group had a higher proportion of patients who had positive RUTs for both locations, whereas the PDH group had a higher proportion of patients who had positive RUTs for only one location.
CONCLUSION As RUT results are significantly affected by the use of acid suppression and antibiotic therapies, biopsies for RUT should be taken from both the gastric antrum and body to minimise false negative results.
Keywords: gastric body biopsy, Helicobacter pylori, rapid urease test
Singapore Med J 2014; 55(12): 644-647; http://dx.doi.org/10.11622/smedj.2014178
| 1. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1:1311-5. |
| 2. Wotherspoon AC, Doglioni C, Diss TC, et al. Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori. Lancet 1993; 342:575-7. |
| 3. El-Zimaity HM. Gastric atrophy, diagnosing and staging. World J Gastroenterol 2006; 12:5757-62. |
| 4. Mobley HL. The role of Helicobacter pylori urease in the pathogenesis of gastritis and peptic ulceration. Aliment Pharmacol Ther 1996; 10 suppl 1:57?64. |
| 5. Logan RP, Walker MM, Misiewicz JJ, et al. Changes in the intragastric distribution of Helicobacter pylori during treatment with omeprazole. Gut 1995; 36:12-6. |
| 6. de Boer WA, van Etten RJ, Schade RW, et al. One-day intensified lansoprazole-quadruple therapy for cure of Helicobacter pylori infection. Aliment Pharmocol Ther 1997; 11:109-12. |
|7. Boixeda D, Gisbet JP, de Rafael L, et al. [The importance of obtaining biopsies of the gastric body in the follow-up after eradicating treatment of Helicobacter pylori]. Med Clin (Barc) 1995; 105:566-9. Spanish.|
| 8. Connor SJ, Seow F, Ngu MC, Katelaris PH. The effect of dosing with omeprazole on the accuracy of the 13C-urea breath test in Helicobacter pylori-infected subjects. Aliment Pharmacol Ther 1999; 13:1287-93. |
| 9. Woo JS, el-Zimaity HM, Genta RM, Yousfi MM, Graham DY. The best gastric site for obtaining a positive rapid urease test. Helicobacter 1996; 1:256-9. |
| 10. Weston AP, Campbell DR, Hassanein RS, et al. Prospective, multivariate evaluation of CLOtest performance. Am J Gastroenterol 1997; 92:1310-5. |
| 11. Vassallo J, Hale R, Ahluwalia NK. CLO vs histology: optimal numbers and site of gastric biopsies to diagnose Helicobacter pylori. Eur J Gastroenterol Hepatol 2001; 13:387-90. |
| 12. Lan HC, Chen TS, Li AF, Chang FY, Lin HC. Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy. BMC Gastroenterol 2012; 12:182-91. |
| 13. Fock KM. Helicobacter pylori infection--current status in Singapore. Ann Acad Med Singapore 1997; 26:637-41. |
| 14. Laine L, Lewin D, Naritoku W, Estrada R, Cohen H. Prospective comparison of commercially available rapid urease tests for the diagnosis of Helicobacter pylori. Gastrointest Endosc 1996; 44:523-6. |
| 15. Ching SS, Sabanathan S, Jenkinson LR. Treatment of Helicobacter pylori in surgical practice: a randomised trial of triple versus quadruple therapy in a rural district general hospital. World J Gastroenterol 2008; 14:3855-60. |
| 16. Midolo P, Marshall BJ. Accurate diagnosis of Helicobacter pylori. Urease tests. Gastroenterol Clin North Am 2000; 29:871-8. |
| 17. Fock KM, Katelaris P, Sugano K, et al. Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol 2009; 24:1587-600. |
| 18. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection--the Maastricht IV/Florence Consensus Report. Gut 2012; 61:646-64. |
| 19. Genta RM, Graham DY. Comparison of biopsy sites for the histopathological diagnosis of Helicobacter pylori: a topographic study of H. pylori density and distribution. Gastrointest Endosc 1994; 40:342-5. |
| 20. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007; 102:1808-25. |
| 21. Moon SW, Kim TH, Kim SH, et al. United Rapid Urease Test Is Superior than Separate Test in Detecting Helicobacter pylori at the Gastric Antrum and Body Specimens. Clin Endosc 2012; 45:392-6. |
| 22. Graham DY, Genta R, Evans DG, et al. Helicobacter pylori does not migrate from the antrum to the corpus in response to omeprazole. Am J Gastroenterol 1996; 91:2120-4. |
| 23. Bermejo F, Boixeda D, Gisbert JP, et al. Rapid urease test utility for Helicobacter pylori infection diagnosis in gastric ulcer disease. Hepatogastroenterology 2002; 49:572-5. |
|24. Seth AK, Kakkar S, Manchanda GS. Role of biopsy from gastric corpus in diagnosis of Helicobacter pylori infection in patients on acid suppression therapy. MJAFI 2003; 59:216-7.|