Helicobacter pylori real-time quantitative PCR to examine efficacy of endoscope processing

Helicobacter pylori (H. pylori) is the main cause of peptic ulcer disease. The primary aim of this research is to determine the effectiveness of current endoscope High-Level Disinfection (HLD) at clearing H. pylori. The secondary aim is to evaluate the prevalence of H. pylori in patients undergoing esophagogastric-duodenoscopy (EGD).

This is a prospective study collecting samples from esophagogastroduodenoscopy (EGD) for H. pylori. testing via gastric lavage and after HLD via flushing endoscope with sterile water. The patients' records were reviewed and the fluid obtained was tested for microbiologic culture; urease testing, and qPCR testing using UreA primers and probe.

The study included 202 samples (101 patients). H. pylori was positive in 37%, 21.9% and 2.4% of samples using Urease testing, culture and biopsy respectively. H. pylori was four times more likely to be identified via gastric lavage than by biopsy. qPCR was significantly more likely to be negative after HLD (27 vs 3 patients).

HLD was effective in reducing H. pylori but was not able to totally eliminate H. pylori DNA. qPCR is more sensitive than routine culture but can't accurately determine potential for infection transmission. Gastric lavage may be more effective in detecting H. pylori than histology.