RECENT PROGRESS IN ENDOSCOPY‐BASED DIAGNOSIS OF HELICOBACTER PYLORI INFECTION

Abstract

Recently the Japanese Society for Helicobacter Research (JSHR) published the guideline for the diagnosis and treatment of H. pylori infection. 2 It is estimated that the Japanese Ministry of Health and Welfare will approve the diagnosis and treatment of H. pylori infection as the health insurancecovered medical services in the near future. The aim of this paper is to review current endoscopy-based diagnostic modalities for H. pylori infection and to emphasize their preferential indications, taking into account the particular settings in which a diagnosis is to be made. BIOPSY SITE, NUMBER AND BIOPSY FORCEPSIt is now well-recognized that persistent H. pylori infection develops atrophic gastritis leading to intestinal metaplasia. Intestinal metaplasia and patchy distribution of the bacteria are thought to be factors causing false-negative diagnoses of H. pylori infection. There are several reports regarding biopsy sites and number for the accurate diagnosis of H. pylori infection. Hazzel et al. reported that it was necessary to take biopsies from both the antrum and the body, as H. pylori might be found in either of them. 5 Genta and Graham reported that two antral biopsy specimens, one from lesser curvature and one from greater curvature, yield virtually 100% sensitivity for the histological detection of H. pylori infection. They also recommended three biopsy specimens (one from each of lesser curvature and greater curvature of the antrum and greater curvature of the corpus) as a routine evaluation of H. pylori infection, because no patients having extensive atrophic gastritis with intestinal metaplasia were included in their series. 3 Satoh et al. indicated that the Digestive Endoscopy (2001) 13, 3-6Numerous invasive and non-invasive tests are available in the detection of Helicobacter pylori. Endoscopy-based tests that include rapid urease test, histological examination and culture are important generally in the assessment of H. pylori status before eradication therapy. Recently, several new endoscopy-based diagnostic methods have been developed aiming at rapid and accurate detection of the organisms. It would be possible to diagnose H. pylori infection in treated patients by using these new highly sensitive tests. Although the diagnosis of H. pylori infection itself is possible by using non-invasive diagnostic tests, endoscopy-based tests provide not only the diagnosis of the organisms, but also the exclusive information such as treatment indications and the susceptibility for the antimicrobial drugs. Recently, new triple therapy including clarithromycin has been widely performed in Japan. Along with an increase in the prevalence of the antibiotic-resistant strains, culture may become a more important diagnostic method in the future. The inappropriate application of the tests may increase the potential risk of the misdiagnosis and the treatment failures. The diagnostic method should be selected by taking into account the circumstances in which a diagnosis is to be performed.

Optimal serological tests for the detection of Helicobacter pylori infection in the Chinese population

“… 2 Since the first successful isolation of the organism from the human stomach in 1982, several tests have been developed to detect the infection, with acceptable sensitivity and specificity. These include invasive (or biopsy‐based tests: mainly culture, histology and rapid urease test) and non‐invasive (mainly 13 C‐ or 14 C‐urea breath tests and serological tests) tests 3–5 . Whereas invasive tests are used for establishing the `gold standard' and provide strains for further investigations, including antibiotic susceptibility testing and genotyping, non‐invasive tests can be used for large‐scale epidemiological studies, for monitoring the clinical efficacy of anti‐ H. pylori eradication therapy and for situations in which endoscopy is not suitable, such as in children and in those with severe illness 6 , .…”