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Standardizing a protocol for Helicobacter pylori gastric biopsy culture: From implementation to sustained practice
Kim Ruiz Arellanos1, Jeff Cardini2, Jill Joerger3
1Harvard Medical and Boston Children's Hospital Department of Pediatrics Boston Massachusetts USA.
Insights
Improving gastric biopsy culture success for Helicobacter pylori diagnosis is crucial. Quality improvement initiatives, including laboratory consolidation and staff education, significantly increased positive culture rates over five years.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Management
- Clinical Quality Improvement
Background:
- Current guidelines recommend gastric biopsy cultures for Helicobacter pylori diagnosis.
- Previous quality improvement efforts focused on enhancing gastric biopsy culture success.
- This study presents 5-year follow-up data on these initiatives.
Purpose of the Study:
- To report 5-year follow-up data on a quality improvement initiative to increase successful gastric biopsy cultures.
- To describe implementation strategies for improving Helicobacter pylori diagnosis via gastric biopsy cultures.
- To guide similar efforts in other pediatric gastroenterology centers.
Main Methods:
- Interventions utilized the plan-do-study-act (PDSA) framework.
- Key interventions included consolidating specialty laboratory processing and providing education/reminders.
- Statistical analyses involved descriptive statistics and logistic regression to assess culture positivity trends.
Main Results:
- A consistent annual increase in obtained gastric biopsy cultures was observed from 2019 to 2025.
- A significant association was found between calendar year and positive culture odds (OR: 2.19, p < 0.001).
- Marked improvement in culture positivity occurred after consolidating laboratory processing.
Conclusions:
- Implemented interventions, including staff education and processing consolidation, likely led to sustained improvements.
- The study highlights successful strategies for enhancing primary gastric biopsy culture success.
- These findings can inform other centers aiming to improve H. pylori diagnostic accuracy.
Objectives:
The 2023 joint North American Society for Pediatric Gastroenterology, Hepatology & Nutrition/European Society for Pediatric Gastroenterology, Hepatology & Nutrition guidelines for Helicobacter pylori infection management continue recommending initial diagnosis via endoscopy with biopsies, and obtaining a gastric biopsy culture. We previously reported on a quality improvement (QI) initiative to improve the rate of successful gastric biopsy culture at our hospital. We present 5-year follow-up data and describe implementation strategies that may guide similar efforts at other centers.
Methods:
Interventions were conducted using the plan-do-study-act (PDSA) framework to: (1) consolidate specialty laboratory processing to a single outside laboratory, and (2) educate and provide reminders to gastroenterologists, endoscopy suite personnel, and laboratory staff. Descriptive statistics were performed on all collected variables. Differences in culture positivity by year, and before and after consolidation to a single specialty laboratory, were assessed using logistic regression, and a p-chart was constructed to determine variation. All analyses were conducted using R (version 2025.05).
Results:
Between November 1, 2019, and March 31, 2025, we observed a consistent increase in the number of gastric biopsy cultures obtained by gastroenterologists each year. Among patients with positive histology, a logistic regression model demonstrated a significant association between calendar year and the odds of a positive culture (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.7-2.9, p < 0.001). A marked improvement in culture positivity was observed following the intervention to consolidate specialty laboratory processing.
Conclusion:
The implemented interventions, such as staff education, standardized checklists, and processing consolidation, may have led to sustained improvements in the success of primary gastric biopsy cultures.
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