Endoscopic diagnosis of Helicobacter pylori in patients with bleeding peptic ulcers

Helicobacter pylori (H. pylori) is the main etiologic factor for peptic ulcers (PU), and it has been shown that H. pylori eradication therapy is effective in preventing recurrent bleeding from PU.

The aim of this study was to establish the prevalence of H. pylori infection in patients with bleeding PU using two endoscopic-based methods--rapid urease test (RUT) and histology--and to compare their diagnostic accuracy.

All patients underwent emergency endoscopy during which a biopsy specimen from the pre-pyloric antrum for RUT and two other specimens from the antrum and gastric corpus for histological assessment were taken.

Ninety-one patients (52 men, 39 women, aged 18-78 years) were included; 69 patients had duodenal ulcer (DU), 18 had gastric ulcer (GU) and four had both duodenal and gastric ulcers. The most frequent presentation was melena (72.5%). Hemoglobin concentration ranged from 3.9 to 14.8 g/dL, and blood in the stomach was present in 59 (64.8%) of patients. Sixty-two patients (68.9%) were diagnosed by RUT as H. pylori-positive, while 81 patients (89.0%) were found to be positive by histology, the difference being statistically significant (p = 0.0048, 95% CI) The sensitivity and specificity of RUT were 76.5% and 100%, respectively. The presence of blood in the stomach did not influence the results of both RUT and histology. The study confirmed the high prevalence of H. pylori infection in patients with bleeding DU.

RUT has a low sensitivity, and thus it is unreliable for the diagnosis of H. pylori infection in patients with bleeding PU; however, RUT has a high specificity and therefore, it should be used as the first choice test for the diagnosis of H. pylori in such patients undergoing emergency endoscopy. Additional biopsies should be taken during endoscopy and proceeded with histological examination when RUT is negative.