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. 2016 Dec;4(6):762-769.
doi: 10.1177/2050640615626052. Epub 2016 Jan 8.

Real-world Helicobacter pylori diagnosis in patients referred for esophagoduodenoscopy: The gap between guidelines and clinical practice

Dor Shirin  1 , Shay Matalon  1 , Benjamin Avidan  2   3 , Efrat Broide  1   3 , Haim Shirin  1   3
Affiliations

Real-world Helicobacter pylori diagnosis in patients referred for esophagoduodenoscopy: The gap between guidelines and clinical practice

Dor Shirin et al. United European Gastroenterol J. 2016 Dec.

Abstract

Background and aims: Histopathology is the most accurate test to detect H. pylori when performed correctly with unknown validity in daily practice clinic settings. We aimed to determine the rate of potentially false-negative H. pylori results that might be due to continued use of proton pump inhibitors (PPIs) in routine endoscopy practice. We also aimed to establish whether gastroenterologists recommend routine cessation of PPIs before esophagogastroduodenoscopy (EGD) and whether they regularly document that biopsies for H. pylori testing have been taken while the patients are on PPI treatment.

Methods: Detailed information about three known factors (PPIs, antibiotics and prior H. pylori eradication treatment), which may cause histology or rapid urease test (RUT) to be unreliable, had been prospectively collected through interviews using a questionnaire before each test. Gastric biopsies were stained with H&E for histological analysis.

Results: A total of 409 individuals at three academic gastroenterology institutions were tested 200 times with histology. Fifty-six per cent (68 of 122) of all negative tests fell in the category of continuing PPI use, which had the potential to make the histology and RUT results unreliable.

Conclusions: These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the diagnosis of H. pylori during EGD. A negative histology or RUT should be considered false negative until potential protocol violations are excluded. Documentation of PPI use during the EGD should be an integral part of the EGD report. The current practice of taking biopsies for H. pylori testing in patients under PPIs should be reevaluated.

Keywords: Helicobacter pylori; esophagogastroduodenoscopy; histopathology; proton pump inhibitor; rapid urease test.

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Figures

Figure 1.
Figure 1.
Indications for gastroscopy and H. pylori testing. IDA: iron-deficiency anaemia; GERD: gastro-oesophageal reflux disease.
Figure 2.
Figure 2.
Endoscopic diagnosis.
Figure 3.
Figure 3.
Histopathology results.
Figure 4.
Figure 4.
HP results in patients with or without PPIs. HP: Helicobacter pylori; PPI: proton pump inhibitor.
Figure 5.
Figure 5.
Biopsies taken under PPI – comparison between three medical centres. PPI: proton pump inhibitor.
See this image and copyright information in PMC

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