Some studies suggest that acute gastrointestinal (GI) bleeding decreases the sensitivity of Helicobacter pylori diagnostic testing.
Dr Loren Laine and colleagues from California assessed H pylori biopsy testing for acute upper-GI bleeding.
The research team conducted a prospective cohort study using 61 patients with acute variceal bleeding as their own controls, in an urban county hospital.
The team undertook antral and body endoscopic biopsies at admission and 1 month later.
CLOtest and histologic examinations were performed.
The biopsy specimens were coded and mixed for blinded histologic examination for H pylori density and inflammation.
The team found that CLOtest results changed from H pylori negative at baseline to positive at 1 month in 3%.
CLOtest results changed from H pylori positive to negative in 10%, and remained the same in 87%.
|CLOtest sensitivity was 8% higher with bleeding vs 1 month after bleeding|
Histologic results changed from H pylori negative at baseline to positive at 1 month in 3%.
The team observed the histological results changed from H pylori positive to negative in 8%, and remained the same in 89%.
The researchers noted that changes occurred only in patients with low H pylori density.
No significant increase in H pylori density or change in inflammatory cell infiltration was seen.
The researchers discovered that CLOtest sensitivity was 8% higher with bleeding vs 1 month after bleeding.
The maximal potential decrease in sensitivity with bleeding was 11%.
The team noted that H pylori testing is not recommended for this population, and that this was a limitation of the results.
A further limitation of this study was that biopsy test performance was less consistent than expected.
Dr Laine's team commented, “Acute-GI bleeding did not decrease the sensitivity of rapid urease testing, unless the effect lasts more than 1 month.”
“Furthermore, bleeding did not produce falsely negative histologic examinations for H pylori, decrease H pylori density, or alter inflammatory cell infiltration.”
“However, given the lower than expected overall CLOtest sensitivity and frequent use of proton pump inhibitors for GI bleeding, histology may be preferred in this setting.”