The Helicobacter pylori detection rate by using combination of rapid urease test at antrum and body vs histopathology in population who stop proton pump inhibitor less than 2 weeks

Background

Helicobacter pylori (H pylori) assessment in patients who stop taking proton pump inhibitor (PPI) in less than 2 weeks has never been established. Experts have suggested using pathology rather than rapid urease test (RUT). Unfortunately, pathology is not widely available in limited resource areas. We aimed to evaluate the detection rate of RUT at antrum and body compared with pathology in those patients.

Methods

Sixty-seven patients with history of PPI use for at least 2 weeks and continued use within 2 weeks prior to gastroscopy were enrolled. Two biopsies were taken from antrum and body for RUT and pathology. Positive test was determined by either RUT or haematoxylin and eosin and giemsa or immunohistochemistry.

Results

Most patients were female (71.6%) with mean age of 52 years. Mean duration of PPI withhold was 3.6 ± 3.8 days. Nearly half (41.8%) were documented H pylori infection in this study. Detection rate of RUT and histopathology was 28.3% and 23.9% at antrum (P = .54, RR 1.18, 95% CI 0.67-2.11) and 34.3% and 28.4% at body (P = .28, RR 0.28, 95% CI 0.73-2.01) respectively. The detection rate was up to 38.8% when combining RUT at antrum and body but did not change when combining those locations for pathology (28.4%) (P = .06, RR 1.37, 95% CI 0.84-2.22).

Conclusion

In patients who have been recently taking PPI, the H pylori detection rate from combination of RUT at antrum and body is not different from pathology. In case where cost may be of concern, RUT from both antrum and corpus can be considered as the diagnostic tool. (ClinicalTrials.gov: NCT04233684).