Aims:
Testing for Helicobacter pylori (H. p.) is frequently conducted during esophagogastroduodenoscopy
(EGD). Proton-pump inhibitors (PPI), upper gastrointestinal bleedings and recent antibiotic
treatment deteriorate H. p. test quality.
Aim of our study was to evaluate the pattern of H. p. suppressive conditions in patients
undergoing elective EGD in a large German university hospital.
Methods:
The survey was performed as a single center study in outpatients as well as inpatients.
Over 6 months, every elective EGD was included and suppressive conditions were assessed.
If H. p. testing was indicated according to guidelines, always both histology and
rapid urease test (RUT) were conducted in analogy to the Sydney classification.
Results:
1631 patients were included (median 61 years, 36,0% outpatients, 64,0% inpatients).
Overall, 76,5% were under H. p. suppressive conditions. Major suppressive condition
was the intake of PPI (70,7%). 50,2% of all patients were tested. 82,7% were negative
for both tests. Of those, 70,0% were tested under suppressive conditions with a high
risk of false negative results. 17,3% had a positive H. p. testing. Here, only 9,9%
showed an incongruent result (14,3% positive for RUT only and 85,7% positive for histology
only). These discrepancies only occurred under suppressive conditions.
Conclusions:
Obviously, guidelines unanimously recommend H. p. testing under non-suppressive conditions.
However, this often does not meet the clinical requirements. Especially, the demanded
withdrawal of proton-pump inhibitors can often not be realized.
Our data represent the real clinical circumstances of testing in patients undergoing
EGD with more than 60% of outpatients and even more than 80% of inpatients showing
suppressive conditions leading to potentially more false negative results. In this
respect, the present guidelines might not be expedient enough. Further research is
needed to improve and clarify everyday clinical practice.
