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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 United+European+Gastroenterol+J
2016 ; 4
(6
): 762-769
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Real-world Helicobacter pylori diagnosis in patients referred for
esophagoduodenoscopy: The gap between guidelines and clinical practice
#MMPMID28408993
Shirin D
; Matalon S
; Avidan B
; Broide E
; Shirin H
United European Gastroenterol J
2016[Dec]; 4
(6
): 762-769
PMID28408993
show ga
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.