Is Real-Time Testing for Helicobacter Pylori and Corpus Atrophy Clinically Useful in 2005?

Introduction

Tucci et al. describe a new approach to the rapid detection of Helicobacter pylori infection and atrophic gastritis [1]. They present details of their new device that automatically and accurately measures both gastric juice ammonia levels and pH. The device is attached directly to the suction channel of the endoscope where it automatically collects and assays the sample and then provides the results verbally while the endoscopic procedure is still in progress. The cost per test (excluding the cost of the device and its maintenance) is low and the reported accuracy was excellent.

Measurements of pH and ammonia in the gastric juice have a long history [2]. Over time they were abandoned for new approaches that provided clinically more useful information. The new device was developed to provide simple and accurate real-time measurements with the thought that this information would be clinically useful in terms of time and cost savings required to arrive at a clinically useful diagnosis. The authors compared the results of their new device with a host of traditional measurements, including the noninvasive urea breath test and H. pylori serology as well as tests based on obtaining samples by endoscopy, including histology and rapid urease testing. They showed that, at least in their population, the results with the new device were superior to those obtained by “routine” histology or the rapid urease test they used. They proposed that their device allowed the reliable detection of atrophic gastritis of the oxyntic mucosa, which was labeled as a “risk-associated condition”. The premise is that endoscopist would receive the information in time to select those patients in whom time-consuming and expensive tests such as gastric mucosal biopsy were warranted, and they propose that targeting testing to the population at risk should result in a savings in terms of time and overall costs.

References

• 1 Tucci A, Tucci P, Bisceglia M. et al . Real-time detection of Helicobacter pylori infection and atrophic gastritis: comparison between conventional methods and a novel device for gastric juice analysis.  Endoscopy. 2005;  37
• 2 Graham D Y, Go M F, Evans D J. Urease, gastric ammonium/ammonia, and Helicobacter pylori - the past, the present, and recommendations for future research.  Aliment Pharmacol Ther. 1992;  6 659-669
• 3 Stadelmann O, Elster K, Stolte M. et al . The peptic gastric ulcer - histotopographic and functional investigations.  Scand J Gastroenterol. 1971;  6 613-623
• 4 Shiotani A, Graham D Y. Pathogenesis and therapy of gastric and duodenal ulcer disease.  Med Clin N Am. 2002;  86 1447-1466
• 5 Woo J S, El-Zimaity H M, Genta R M. et al . The best gastric site for obtaining a positive rapid urease test.  Helicobacter. 1996;  1 256-259
• 6 Yousfi M M, El-Zimaity H M, Cole R A. et al . Does using a warmer influence the results of rapid urease testing for Helicobacter pylori?.  Gastrointest Endosc. 1996;  43 260-261
• 7 Yousfi M M, El-Zimaity H M, Cole R A. et al . Detection of Helicobacter pylori by rapid urease tests: is biopsy size a critical variable?.  Gastrointest Endosc. 1996;  43 222-224
• 8 Ho A S, Young T H, Shyu R Y. et al . The accuracy of the rapid urease test and 13C-urea breath test in the diagnosis of Helicobacter pylori infection.  Chung Hua I Hsueh Tsa Chih (Taipei). 1996;  58 400-406
• 9 Ho K Y, Kang J Y, Lim T P. et al . The effect of test duration on the sensitivity and specificity of ultra-rapid urease test for the detection of Helicobacter pylori infection.  Aust NZ J Med. 1998;  28 615-619
• 10 Nakayama Y, Graham D Y. Helicobacter pylori infection: diagnosis and treatment.  Expert Rev Anti-Infect Therapy. 2004;  2 599-616
• 11 Malfertheiner P, Megraud F, O'Morain C. et al . Current concepts in the management of Helicobacter pylori infection - the Maastricht 2-2000 Consensus Report.  Aliment Pharmacol Ther. 2002;  16 (2) 167-180
• 12 Miki K, Ichinose M, Shimizu A. et al . Serum pepsinogens as a screening test of extensive chronic gastritis.  Gastroenterol Jpn. 1987;  22 133-141
• 13 Varis K, Kekki M, Harkonen M. et al . Serum pepsinogen I and serum gastrin in the screening of atrophic pangastritis with high risk of gastric cancer.  Scand J Gastroenterol. 1991;  186 Suppl 117-123
• 14 Graham D Y, Shiotani A. The time to eradicate gastric cancer is now.  Gut. 2005;  54 735-738
• 15 Graham D Y, Kudo M, Reddy R, Opekun A R. Practical rapid, minimally invasive, reliable nonendoscopic method to obtain Helicobacter pylori for culture.  Helicobacter. 2005;  10 1-3
• 16 Graham D Y. The changing epidemiology of GERD: geography and Helicobacter pylori.  Am J Gastroenterol. 2003;  98 1462-1470