The success of eradication therapy for Helicobacter pylori infection is usually determined by noninvasive tests; however, sometimes these tests are not possible and an invasive test is required such as the rapid urease test (RUT), or histology. AIM: To evaluate and compare the accuracy of the RUT with that of histology for determining H. pylori eradication after therapy. DESIGN: this European, prospective study included patients who fulfilled the Maastricht criteria for H. pylori infection. All patients had received H. pylori eradication therapy with twice-daily omeprazole (20 mg) and twice-daily amoxicillin (100 mg) and clarithromycin (250 mg or 500 mg) or metronidazole (400 mg) for 1 week. Upper gastrointestinal endoscopy was performed in all patients 1 month after completion of H. pylori eradication therapy. Use of PPIs or histamine-receptor antagonists was prohibited in the week before endoscopy. During endoscopy, biopsies were taken for histologic evaluation and the RUT—two biopsies were taken 3 cm from the pylorus from the greater curvature of the antrum, and two biopsies were taken from the greater curvature in the middle of the corpus. The results of the RUT were read at 1 h, 3 h and 24 h after performing the test. Biopsy samples for histology were stained with hematoxylin and eosin, and Giemsa stain. Gastrointestinal pathologists, who were blinded to the RUT results, reviewed histologic How useful is the rapid urease test for evaluating the success of Helicobacter pylori eradication therapy? data. Agreement between the results obtained with the RUT and those obtained with histology was assessed. OUTCOME: The primary outcome measures were the eradication of H. pylori and agreement between diagnostic tests. RESULTS In total, 232 patients were included. The results of histology and the RUT from antrum biopsies showed that H. pylori was eradicated in 181 patients, and 51 patients remained H. pylori- positive. For biopsies taken from the antrum, agreement between the RUT and histology was excellent (94% k 0.81 [95% CI 0.77–0.85]); the sensitivity and specificity of the RUT at this biopsy location was 80.4% (95% CI 79.5–80.9) and 98.3% (95% CI 97.8– 98.85%), respectively. The results of histology and the RUT from corpus biopsies showed that H. pylori was eradicated in 185 patients, and 47 patients remained H. pylori-positive. For biopsies taken from the corpus, agreement between the RUT and histology was excellent (97% k 0.87 [95%CI 84.6–85.6]; the sensitivity and specificity of the RUT at this biopsy location was 85.1% (95% CI 84.6–85.6) and 100%, respectively. The results of histology and the RUT from antrum and corpus biopsies showed that H. pylori was eradicated in 177 patients, and 55 patients remained H. pylori-positive. Pooled data analysis revealed that agreement between the two invasive tests was excellent (86% k 0.84 [95% CI 0.80–0.88]); the overall sensitivity and specificity of the RUT test was 83.6% (95% CI 83.1–84.1) and 99.4% (95% CI 98.9–99.9), respectively. CONCLUSION The eradication of H. pylori after therapy can be accurately determined with the RUT using two biopsies taken from the antrum and corpus.
D. Vaira, F. Perna. (2007). How useful is the rapid urease test for evaluating the success of Helicobacter pylori eradication therapy?. NATURE CLINICAL PRACTICE GASTROENTEROLOGY & HEPATOLOGY, 4, 600-601 [10.1038/ncpgasthep0966].
How useful is the rapid urease test for evaluating the success of Helicobacter pylori eradication therapy?
VAIRA, BERARDINO;PERNA, FEDERICO
2007
Abstract
The success of eradication therapy for Helicobacter pylori infection is usually determined by noninvasive tests; however, sometimes these tests are not possible and an invasive test is required such as the rapid urease test (RUT), or histology. AIM: To evaluate and compare the accuracy of the RUT with that of histology for determining H. pylori eradication after therapy. DESIGN: this European, prospective study included patients who fulfilled the Maastricht criteria for H. pylori infection. All patients had received H. pylori eradication therapy with twice-daily omeprazole (20 mg) and twice-daily amoxicillin (100 mg) and clarithromycin (250 mg or 500 mg) or metronidazole (400 mg) for 1 week. Upper gastrointestinal endoscopy was performed in all patients 1 month after completion of H. pylori eradication therapy. Use of PPIs or histamine-receptor antagonists was prohibited in the week before endoscopy. During endoscopy, biopsies were taken for histologic evaluation and the RUT—two biopsies were taken 3 cm from the pylorus from the greater curvature of the antrum, and two biopsies were taken from the greater curvature in the middle of the corpus. The results of the RUT were read at 1 h, 3 h and 24 h after performing the test. Biopsy samples for histology were stained with hematoxylin and eosin, and Giemsa stain. Gastrointestinal pathologists, who were blinded to the RUT results, reviewed histologic How useful is the rapid urease test for evaluating the success of Helicobacter pylori eradication therapy? data. Agreement between the results obtained with the RUT and those obtained with histology was assessed. OUTCOME: The primary outcome measures were the eradication of H. pylori and agreement between diagnostic tests. RESULTS In total, 232 patients were included. The results of histology and the RUT from antrum biopsies showed that H. pylori was eradicated in 181 patients, and 51 patients remained H. pylori- positive. For biopsies taken from the antrum, agreement between the RUT and histology was excellent (94% k 0.81 [95% CI 0.77–0.85]); the sensitivity and specificity of the RUT at this biopsy location was 80.4% (95% CI 79.5–80.9) and 98.3% (95% CI 97.8– 98.85%), respectively. The results of histology and the RUT from corpus biopsies showed that H. pylori was eradicated in 185 patients, and 47 patients remained H. pylori-positive. For biopsies taken from the corpus, agreement between the RUT and histology was excellent (97% k 0.87 [95%CI 84.6–85.6]; the sensitivity and specificity of the RUT at this biopsy location was 85.1% (95% CI 84.6–85.6) and 100%, respectively. The results of histology and the RUT from antrum and corpus biopsies showed that H. pylori was eradicated in 177 patients, and 55 patients remained H. pylori-positive. Pooled data analysis revealed that agreement between the two invasive tests was excellent (86% k 0.84 [95% CI 0.80–0.88]); the overall sensitivity and specificity of the RUT test was 83.6% (95% CI 83.1–84.1) and 99.4% (95% CI 98.9–99.9), respectively. CONCLUSION The eradication of H. pylori after therapy can be accurately determined with the RUT using two biopsies taken from the antrum and corpus.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
