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Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding
J M Lee1, N P Breslin, C Fallon
1Department of Gastroenterology, Meath Hospital, Trinity College, Dublin, Ireland.
Insights
The rapid urease test (RUT) is less effective for diagnosing Helicobacter pylori in bleeding duodenal ulcers. Alternative diagnostic methods are recommended for this patient group to ensure accurate H. pylori detection.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Diagnostic Medicine
Background:
- Helicobacter pylori (H. pylori) eradication reduces rebleeding in peptic ulcer disease (PUD).
- Diagnostic accuracy of H. pylori tests is established for uncomplicated PUD.
- The efficacy of the rapid urease test (RUT) in bleeding PUD remains unevaluated.
Purpose of the Study:
- To evaluate the diagnostic efficacy of the RUT (CLOtest) for H. pylori in patients with bleeding duodenal ulcers (DUs).
Main Methods:
- Patients with bleeding DUs and upper GI hemorrhage underwent endoscopy.
- H. pylori detection utilized RUT, microbiology, and histology.
- Prevalence by RUT alone was compared to combined methods in bleeding and non-bleeding DU groups.
Main Results:
- H. pylori prevalence was lower in bleeding DUs (72.7%) versus non-bleeding DUs (92.8%).
- RUT alone showed lower prevalence (54.5%) than combined methods (73%) in bleeding DUs, with a 25% false-negative rate.
- This false-negative rate was significantly higher than in non-bleeding DU patients (1.6%).
Conclusions:
- H. pylori prevalence is lower in bleeding duodenal ulcers compared to uncomplicated cases.
- RUT demonstrates reduced sensitivity and negative predictive value in bleeding DU patients.
- Alternative H. pylori diagnostic methods are advised for patients with bleeding duodenal ulcers.
Objective:
The eradication of Helicobacter pylori (H. pylori) in patients with bleeding peptic ulcer disease (PUD) decreases the rate of ulcer rebleeding. Although all methods for H. pylori diagnosis have been extensively evaluated in uncomplicated PUD the efficacy of the commonly used rapid urease test (RUT) has not been established in patients with bleeding peptic ulcer disease. The aim of this study was to evaluate the efficacy of the RUT (CLOtest) in patients with bleeding duodenal ulcers (DUs).
Methods:
Consecutive patients with symptoms of upper GI tract hemorrhage and a DU at the time of endoscopy were evaluated. The presence of H. pylori infection was determined by RUT, microbiology, and histology. Consecutive patients with uncomplicated DUs were similarly evaluated. The prevalence of H. pylori as determined by the RUT alone was compared to that determined by a combination of all tests in both patient groups.
Results:
Fifty-five patients with bleeding DUs and 69 with nonbleeding DUs were evaluated. The prevalence of H. pylori in patients presenting with bleeding was 72.7% (95% confidence interval [CI] 61.0-84.5%) and lower than the prevalence rate of 92.8% (95% CI 86.6-98.8%) in patients with uncomplicated PUD (p < 0.05). The prevalence of H. pylori in the bleeding DU group as determined by RUT alone (54.5%) was less than that determined by a combination of all tests (73%) with a false-negative rate of 10 of 40 (25%; 95% CI 11.6-38.4%) (p < 0.05). This false-negative rate was significantly greater than that observed in the group presenting with dyspepsia (1 of 64 [1.6%; 95% CI 0-4.6%]) (p < 0.01).
Conclusions:
The prevalence of H. pylori is lower in patients with bleeding DUs when compared to patients with uncomplicated DUs. In addition, the sensitivity and negative predictive value of the RUT is lower in patients presenting with bleeding, and other methods of H. pylori diagnosis should be used in this patient group.