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Prospective, multivariate evaluation of CLOtest performance
A P Weston1, D R Campbell, R S Hassanein
1Department of Veterans Affairs Medical Center, Kansas City, Missouri 64128-2226, USA.
Insights
Optimizing Helicobacter pylori detection with the CLOtest involves using biopsy samples from both the antrum and body. Alcohol consumption, race, and prior eradication attempts can influence test accuracy.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Diagnostic Microbiology
Background:
- The CLOtest is a rapid diagnostic method for detecting Helicobacter pylori (H. pylori) infection.
- Accurate H. pylori diagnosis is crucial for effective treatment and management of related gastrointestinal conditions.
- Factors influencing CLOtest performance require further investigation to enhance diagnostic yield.
Purpose of the Study:
- To prospectively evaluate the impact of various factors on the performance of the CLOtest for H. pylori detection.
- Key factors examined include medication use (aspirin, NSAIDs, H2-blockers, PPIs), alcohol intake, race, age, prior H. pylori eradication history, and gastric biopsy site.
Main Methods:
- Prospective study involving 117 patients, with 50 confirmed H. pylori infections.
- Gastric biopsy specimens were collected from the antrum, greater curve, and proximal stomach.
- H. pylori status was definitively determined using Giemsa staining, with CLOtest performance compared against histopathology results from different biopsy sites.
Main Results:
- CLOtest sensitivity and specificity varied based on biopsy site; combining antrum and body samples improved sensitivity to 82.0%.
- Absence of alcohol consumption was significantly associated with CLOtest concordance (p < 0.02).
- No history of H. pylori eradication attempts (p = 0.04) and African-American race (p < 0.03) were also independently associated with CLOtest accuracy in specific sites.
Conclusions:
- Collecting gastric biopsy specimens from both the antrum and body enhances CLOtest sensitivity for H. pylori detection.
- CLOtest performance is demonstrably influenced by demographic and clinical factors, including alcohol consumption, race, and eradication history.
Objectives:
To determine prospectively the effect of aspirin, nonsteroidal anti-inflammatory drugs, H2-receptor antagonists, proton pump inhibitors, alcohol intake, race, age, history of Helicobacter pylori eradication attempts, and gastric biopsy location on CLOtest performance.
Methods:
Biopsy specimens were obtained from the antrum, greater curve, and proximal stomach. One biopsy specimen from each site (except for the proximal stomach) was used for the CLOtest and two or more specimens were used for histopathology. Giemsa staining was used for the definitive determination of H. pylori status.
Results:
One hundred seventeen patients were included in the study, and 50 of these were infected with H. pylori. The sensitivity and specificity of an antral CLOtest, based on the results of Giemsa-stained sections from the antrum alone, were 72.7 and 98.6%, respectively, whereas they were 66.0 and 100% when based on the results of Giemsa-stained sections from all three gastric biopsy sites. The sensitivity and specificity of a body CLOtest, based on the results of Giemsa-stained sections from the body alone, were 80.5% and 93.4%, whereas they were 76.0% and 100% when based on the results of Giemsa-stained sections from all three gastric biopsy sites. Combining CLOtest results from the antrum and body increased CLOtest sensitivity to 82.0%. Univariate analysis revealed only one factor significantly associated with CLOtest concordance: absence of alcohol consumption (p < 0.02). Stepwise logistic regression demonstrated that absence of alcohol use again was independently associated with the concordance between overall CLOtest and all Giemsa-stained biopsy specimen results (p < 0.03) as well as between body CLOtest and body Giemsa-stained biopsy specimen results (p < 0.03). Additional independent and significant associations were noted between antral CLOtest-antral Giemsa-stained biopsy specimen results and no history of H. pylori eradication attempts (p = 0.04) and between body CLOtest-body Giemsa-stained biopsy specimen results and race (African-American) (p < 0.03).
Conclusions:
Obtaining a gastric biopsy specimen from the antrum as well as from the body increased CLOtest detection of H. pylori. CLOtest performance was shown to be affected by several demographic and clinical factors.