Diagnostics of Helicobacter pylori Infection in Patients with Peptic Ulcer Bleeding

Zusammenfassung

Hintergrund: Bei der peptischen Ulkusblutung wurde über eine insuffiziente Sensitivität von H.-pylori-Tests, insbesondere des Urease-Schnelltests (RUT), berichtet. Ziele: Validierung von RUT, Serologie und Harnstoff-Atemtest bei Patienten mit peptischer Ulkusblutung. Untersuchung des Einflusses von H.-pylori-suppressiver Behandlung (HpSuT), d. h. Antibiotika und Protonenpumpenhemmer. Patienten und Methoden: 123 konsekutive Patienten (mittleres Alter 65,5 Jahre) mit einer relevanten Blutung aus gastroduodenalen Ulzera wurden prospektiv auf eine H.-pylori-Infektion untersucht mittels direkten Tests (RUT, Histologie, Kultur und Harnstoff-Atemtest) und Serologie als indirekten Tests. Ein positiver H.-pylori-Status wurde durch positive Ergebnisse von Histologie oder Kultur definiert. Ergebnisse: Bei Patienten ohne HpSuT in den letzten vier Wochen (n = 83) lagen Sensitiviät und Spezifität des RUT bei 94 und 84 %, der Serologie bei 83 und 68 %. Die Sensitivität des Harnstoff-Atemtests sank von 82 auf 60 % nach nur einem Tag mit HpSuT. In der Gesamtgruppe erwiesen sich die Dauer der HpSuT und eine vorangehende Hospitalisation als unabhängige Faktoren für negative Resultate aller direkten Tests. Schlussfolgerungen: Bei peptischer Ulkusblutung ist der RUT kombiniert mit Histologie ein geeignetes Diagnostikum. Jedoch sollten mögliche falsch negative Ergebnisse nach kurzfristiger HpSuT oder Hospitalisation in Betracht gezogen werden. Eine nicht invasive Diagnose, basierend allein auf der Serologie, ist nicht treffsicher und sollte durch einen Harnstoff-Atemtest vor Beginn einer HpSuT ergänzt werden.

Abstract

Background: In peptic ulcer bleeding, the sensitivity of H. pylori tests, in particular of the rapid urease test (RUT), has been reported to be insufficient. Aim: To validate the RUT, serology and the urea breath test were carried out in patients with bleeding peptic ulcers, and to study the influence of H. pylori suppressive treatment (HpSuT), i. e., antibiotics and proton pump inhibitors. Patients and Methods: 123 consecutive patients (mean age 65.5 years) with a relevant bleeding from gastric or duodenal ulcers were prospectively tested for H. pylori infection by directs tests (RUT, histology, culture, urea breath test) and by IgG serology as an indirect test. Positive H. pylori status was defined by positive histology or culture. Results: In patients without HpSuT during the preceding four weeks (N = 83), the sensitivity and specificity of RUT was 94 and 84 %, that of serology 83 and 68 % respectively. The sensitivity of urea breath test decreased from 82 to 60 % after even one day of HpSuT. In the overall group, the duration of HpSuT and preceding hospitalization were independent factors linked with negative results of all direct tests. Conclusions: In peptic ulcer bleeding, RUT combined with histology is an adequate diagnostic approach. However, false negative results have to be considered following even short-term HpSuT or hospitalization. Non-invasive diagnosis based on serology alone is inaccurate and should be complemented by the urea breath test prior to starting HpSuT.

Helicobacter pylori - peptische Ulkusblutung - Diagnose - Urease-Schnelltest - Histologie - Kultur - Serologie - Harnstoff-Atemtest

Helicobacter pylori - peptic ulcer bleeding - diagnosis - rapid urease test - histology - culture - serology - urea breath test

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