Mucosal Brush Sampling Increases the Helicobacter pylori Detection Rate of the Rapid Urease Test: A Pilot Study

Accurate diagnosis of and timely eradication therapy for Helicobacter pylori are crucial for managing and preventing adverse clinical outcomes associated with H. pylori infection. H. pylori infection is typically diagnosed using endoscopic biopsy-based tests such as the rapid urease test (RUT). In this study, we investigated the usefulness of mucosal brush sampling for H. pylori detection using the RUT and culture.

Twenty patients with H. pylori infection underwent endoscopy, and specimens were collected from the greater curvature of the gastric corpus via both mucosal brush and biopsy sampling methods. Brushing was performed using a disposable cytology brush, and the brush specimen was used for the RUT (brush-RUT) and then for culture. Two biopsies were obtained for the RUT (biopsy-RUT) and culture. H. pylori detection rates using RUT and culture yields from brush and biopsy samples were compared.

The H. pylori detection rate was 100% with the brush-RUT, whereas it was 75% with the biopsy-RUT. Notably, among patients taking acid-suppressive agents, the sensitivity of the biopsy-RUT decreased to 66.7%, whereas that of the brush-RUT remained at 100%. The biopsy-RUT yield was also associated with the delta over baseline value determined by the urea breath test. H. pylori was successfully isolated from all the biopsy specimens and 95% of the brush samples, and all H. pylori isolates were tested for antimicrobial susceptibility. No significant procedure-related adverse events occurred with either sampling method.

Mucosal brushing is a simple, effective, and highly sensitive diagnostic method for H. pylori infection. The mucosal brush method is a practical alternative to biopsy, expanding the diagnostic capabilities while minimizing invasiveness.