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The effect of GI bleeding on Helicobacter pylori diagnostic testing: a prospective study at the time of bleeding and 1 month later.

BACKGROUND: Some case series and cohort studies suggest that acute GI bleeding decreases the sensitivity of Helicobacter pylori diagnostic testing. OBJECTIVE: To assess H pylori biopsy testing in patients with acute upper-GI bleeding and 1 month later. DESIGN: Prospective cohort study using patients...

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Published in:Gastrointestinal Endoscopy Vol. 62; no. 6; pp. 853 - 860
Main Authors: Laine LA, Nathwani RA, Naritoku W
Format: research tables/charts Journal Article
Published: Elsevier B.V. Dec2005
Online Access:View this record in EBSCOhost
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      dt: Dec2005
      vid: 62
      iid: 6
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      pub: Elsevier B.V.
      place: New York, New York
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        106350509
        2009298363
        10.1016/j.gie.2005.09.019
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        106350509
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        atl: The effect of GI bleeding on Helicobacter pylori diagnostic testing: a prospective study at the time of bleeding and 1 month later.
      aug:
        au:
          Laine LA
          Nathwani RA
          Naritoku W
        affil: GI Division, Department of Medicine, USC School of Medicine, 2025 Zonal Avenue, Los Angeles, CA 90033
      sug:
        subj:
          Gastrointestinal Hemorrhage Complications
          Helicobacter Infections Diagnosis
          Helicobacter Pylori
          Urease Analysis
          Acute Disease
          Adult
          Aged
          Aged, 80 and Over
          Biopsy
          Confidence Intervals
          Diagnosis, Laboratory Methods
          Esophageal and Gastric Varices Complications
          False Negative Results
          Female
          Fisher's Exact Test
          Funding Source
          Gastrointestinal Hemorrhage Therapy
          Helicobacter Infections Complications
          Male
          Middle Age
          Prospective Studies
          Proton Pump Inhibitors Therapeutic Use
          Sample Size
          Sensitivity and Specificity
          Stomach Microbiology
          Stomach Pathology
          T-Tests
          Time Factors
          Urban Areas
          Human
          Adult: 19-44 years
          Aged: 65+ years
          Aged, 80 & over
          Middle Aged: 45-64 years
          Female
          Male
      ab: BACKGROUND: Some case series and cohort studies suggest that acute GI bleeding decreases the sensitivity of Helicobacter pylori diagnostic testing. OBJECTIVE: To assess H pylori biopsy testing in patients with acute upper-GI bleeding and 1 month later. DESIGN: Prospective cohort study using patients as their own controls. SETTING: Urban county hospital. PATIENTS: Sixty-one patients with acute variceal bleeding. INTERVENTIONS: Antral and body endoscopic biopsies at admission and 1 month later. MAIN OUTCOME MEASUREMENTS: CLOtest and histologic examinations were performed and biopsy specimens were coded and mixed for blinded histologic examination for H pylori density and inflammation. RESULTS: CLOtest results changed from H pylori negative at baseline to H pylori positive at 1 month in two patients (3%), from H pylori positive to H pylori negative in 6 patients (10%), and remained the same in 53 (87%). Histologic results changed from H pylori negative at baseline to H pylori positive at 1 month in two patients (3%), from H pylori positive to H pylori negative in 5 patients (8%), and remained the same in 54 (89%). Changes occurred only in patients with low H pylori density. No significant increase in H pylori density or change in inflammatory cell infiltration was seen. CLOtest sensitivity was 8% higher with bleeding vs. 1 month after bleeding (79% vs. 71%; 95% CI of difference was -11% to 27%; i.e., maximal potential decrease in sensitivity with bleeding is 11%). LIMITATIONS: The population is not one for which H pylori testing is recommended, and biopsy test performance was less consistent than expected. CONCLUSIONS: Acute-GI bleeding did not decrease the sensitivity of rapid urease testing, unless the effect lasts more than 1 month. Furthermore, bleeding did not produce falsely negative histologic examinations for H pylori, decrease H pylori density, or alter inflammatory cell infiltration. However, given the lower than expected overall CLOtest sensitivity and frequent use of proton pump inhibitors for GI bleeding, histology may be preferred in this setting.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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