Abstract
Helicobacter pylori (H. pylori) can cause a wide variety of illnesses such as peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. The diagnosis and eradication of H. pylori are crucial. The diagnosis of H. pylori is usually based on the rapid urease test (RUT) and gastric antral biopsy for histology. The aim of this study is to evaluate the numbers of needed biopsies and their location (antrum/fundus) to obtain optimal result for the diagnosis of H. pylori. Three hundred fifty consecutive patients were recruited, 210 fulfill the inclusion criteria and had nine gastric biopsies for the detection of H. pylori infection: two antral for the first RUT (RUT1), one antral and one fundic for the second (RUT2), one antral for the third (RUT3) and two antral with two fundic for histology (HES, Giemsa, PAS). The reading of the 3 types of RUT was performed at 1 hour, 3 hours and 24 hours and biopsies were read by two experienced pathologists not informed about the result of RUT. Results of RUT were considered positive if H. pylori was found on histology of at least one biopsy. The RUT1 at 1h, 3h and 24h has a sensitivity of 72%, 82% and 89% and a specificity of 100%, 99% and 87% respectively. The positive predictive value (PPV) was 100%, 99% and 85% respectively and the negative predictive value (NPV) of 81%, 87% and 90%. The RUT2 at 1h, 3h and 24h, respectively, had a sensitivity of 86%, 87% and 91% and a specificity of 99%, 97% and 90%. The PPV was 99%, 96% and 88% and NPV of 89%, 90%, 94%. The RUT3 at 1h, 3h and 24h, respectively, had a sensitivity of 70%, 74% and 84% and a specificity of 99%, 99% and 94%. The PPV was 99%, 99% and 92% and NPV of 79%, 81% and 87%. The best sensitivity and specificity were obtained for RUT1 read at 3h, for RUT2 read 1h and 3h, and the RUT3 read at 24h.This study demonstrates that the best sensitivity and specificity of rapid test for urease is obtained when fundic plus antral biopsy specimens are used with a reading time at 3 hours.
Highlights
24 hours and biopsies were read by two n experienced pathologists not informed o about the result of rapid urease test (RUT)
Results of RUT N were considered positive if H. pylori was found on histology of at least one biopsy
The RUT2 at 1h, 3h and 24h, respectively, had a sensitivity of 86%, 87% and cancer, and gastric mucosa associated lymphoid tissue lymphomas and its eradication is recommended in the treatment of these diseases
Summary
During a period of 6 months (from January 2015 till July 2015), 350 consecutive patients who presented for upper endoscopy at Saint Charles Hospital were recruited, after the approval of the ethical committee and signed informed consent. Exclusion criteria were PPI and/or bismuth intake in the last 3 months, antibiotics intake in the last 6 months, active upper gastrointestinal bleeding and coagulation disorders contraindicating gastric biopsy. Abou Rached et al 2017 Licensee PAGEPress, Italy Gastroenterology Insights 2017; 8:7223 doi:10.4081/gi.2017.7223 and read by two experienced pathologists uninformed of the RUT results. The five other biopsies were placed in the Pronto Dry® RUT kits (MIC France, Brignais, France). The reading of different RUTs was performed at the 1st, 3rd and 24th hour. A RUT was considered positive if the color changed from yellow to red, pink or orange. An unchanging yellow color indicated a negative result. Sensitivity, specificity, negative and positive predictive values were calculated using SPSS 20.0 and Excel. Roc curves and Area under curve calculations were performed with SPSS 20.0. The RUT3 at 1h, 3h and 24h, respectively, had a sensitivity of
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