Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy

Abstract

BackgroundThe best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. This study aimed to evaluate the site and sensitivity of biopsy-based tests in terms of degree of gastritis with atrophy.MethodsOne hundred and sixty-four (164) uninvestigated dyspepsia patients were enrolled. Biopsy-based tests (i.e., culture, histology Giemsa stain and rapid urease test) and non-invasive tests (anti-H. pylori IgG) were performed. The gold standard of H. pylori infection was defined according to previous criteria. The sensitivity, specificity, positive predictive rate and negative predictive rate of biopsy-based tests at the gastric antrum and body were calculated in terms of degree of gastritis with atrophy.ResultsThe prevalence rate of H. pylori infection in the 164 patients was 63.4%. Gastritis with atrophy was significantly higher at the antrum than at the body (76% vs. 31%; p<0.001). The sensitivity of biopsy-based test decreased when the degree of gastritis with atrophy increased regardless of biopsy site (for normal, mild, moderate, and severe gastritis with atrophy, the sensitivity of histology Giemsa stain was 100%, 100%, 88%, and 66%, respectively, and 100%, 97%, 91%, and 66%, respectively, for rapid urease test). In moderate to severe antrum or body gastritis with atrophy, additional corpus biopsy resulted in increased sensitivity to 16.67% compare to single antrum biopsy.ConclusionsIn moderate to severe gastritis with atrophy, biopsy-based test should include the corpus for avoiding false negative results.

Impact of the angulus biopsy for the detection of gastric preneoplastic conditions and gastric cancer risk assessment

“…In six cases, H pylori could only be cultured from the corpus (data not shown) as reported previously in cases with extensive atrophy or IM 30. We consider serology useful as recommended in the Maastricht IV guidelines31 because a large number of patients are not PPI naive when scheduled for endoscopic examination.…”

Value of Additional Corpus Biopsy for Diagnosis of Helicobacter Pylori in Atrophic Gastritis

“…Therefore, antrum based biopsy only in case of atrophic gastritis yields to more false negative results [22]. This finding was in concordance with Kang HY et al [23], Satoh K et al [24], Yoo et al [25,26], and Kokkola A et al [14]. This study clarified that the sensitivity of H. pylori detection is decreased in cases of antral atrophic gastritis more than corpus one in the same time as inversely correlated with degree of atrophy.…”

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

“…False-positive tests are unusual; false-negative results can occur in patients with recent GI bleeding or with the use of PPIs, antibiotics, or bismuth-containing compounds or with excessive atrophy and intestinal metaplasia. If RUT is to be performed, patients should be off antibiotics or bismuth for 4 weeks and off PPI therapy for 2 weeks 102 110 111…”