Accuracy of rapid urease test in the diagnosis of H-pylori during bleeding period

The rapid urease test is considered one of the primary diagnostics of Helicobacter pylori infection among patients undergoing upper endoscopy and thanks to its high sensitivity and specificity, cost and reproducibility compared with the histological study. However, many studies suggest that the sensitivity of rapid urease test decreased significantly in patients with bleeding peptic ulcer. The aim of our study is to evaluate the diagnostic performance of rapid urease test in the diagnosis of H. pylori infection in peptic ulcer during bleeding complication. Our work is a prospective study on patients hospitalized for bleeding peptic ulcer, conducted at the hepatogastroenterology unit of University Hospital Hassan II over a period of two years and three months. All patients included in the study have benefited from antral biopsies with search of H. pylori infection in rapid urease test (CLOtest) and histology. One hundred and sixteen patients with bleeding peptic ulcer were admitted during this period. The sensitivity of rapid urease test was 72% with a negative predictive value of 30%, specificity of 88% and positive predictive value of 97%. The presence of blood in the stomach and the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) were the major factors that decrease the sensitivity of this rapid test. The rapid urease test is a test commonly used in practice for the diagnosis of H. pylori infection. Acute bleeding may be responsible for many false negatives due to the presence of blood in stomach and NSAIDs.