5- Evaluation of Endoscopy Based Methods (Histopathology, Cytology and Urease Test) for the Detection of Helicobacter Pylori

Abstract

This study aimed to assess the accuracy of histopathology, brush cytology, and urease test in the diagnosis of Helicobacter pylori and to evaluate the effect of test duration on the sensitivity and spec ificity of positive urease test for the detection of H. pylori. Fifty patients [25 patients with gastritis group A and 25 patients with duodenal ulcer group B] selected from those attending endoscopy unit for dyspeptic symptoms , were enrolled in the study. Four endoscopic biopsies were taken from each patient. One biopsy from each of antrum and body were obtained for urease test (Urease test was read at 30 min, 1, 4 and 24 hour after biopsy insertion into the reagent), and one biopsy from each of antrum and body were used for histopathological examination. Antral brush cytology was taken also fr om each patient. The patients were considered H. pylori positive when minimum concordances of 2 out of 3 tests (Histopathology, brush cytology, and urease test) were positive. Fourteen patients were positive for H. pylori in group A, in comparison to seventeen patients in group B. The sensitivities of the histopathological examin ation, brush cytology, and urease test at 24 hours in group (A) were 58%, 79%, and 93% respectively. Corresponding figures for the specificity were 100%, 91%, and 46% respectively. While in group (B) the sensitiv ities were 82%, 82%, and 100% and the specificities were 100%, 100%, and 88% respectively.It is concluded that among the invasive methods, the association of the urease test with brush cytology constituted the best choice for confirming the diagnosis of H. pylori, due to the high sensitivity of the urease test and high specificity of brush cytology.