Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of Helicobacter pylori infection using only non-invasive tests.
Dr Heidi Maaroos and colleagues undertook a study to compare the diagnostic value of non-invasive and endoscopy based H pylori tests in a late post-treatment setting.
Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a 1-week triple therapy scheme.
The researchers utilized the Sydney classification to evaluate the endoscopic and histologic findings.
The researchers also performed bacteriological, PCR and cytological investigations and 13C-urea breath tests (UBT).
The investigators defined 17 patients as being H pylori positive by 13C-UBT test, PCR and histological examination.
On endoscopy, peptic ulcer persisted in 4 H pylori positive cases.
The researchers found that among the 6 cases with erosions of the gastric mucosa, only two patients were H pylori positive.
|Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H pylori|
The researchers revealed mucosal atrophy and intestinal metaplasia both in the H pylori positive and H pylori negative cases.
Bacteriological examination revealed 3 clarithromycin resistant H pylori strains.
Cytology failed to prove validity for diagnosing H pylori post-treatment setting.
Dr Maaroos concluded, "In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods"
"It is also justified to use the classical histological evaluation of H pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT."
"Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value."
"They provide the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H pylori positive and negative patients."
"Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H pylori, aimed at successful eradication of infection in persistent peptic ulcer cases."