Rapid urease test from non-ulcer part of stomach is superior to histology from ulcer in detection of Helicobacter pylori infection in patients with gastric ulcer

Background/Aims: Helicobacter-pylori is the major pathogenesis of peptic ulcer disease. It is important for the endoscopists to detect H. pylori infection during endoscopy. Only one endoscopic diagnostic method can be used due to the limitation of health insurance payments in Taiwan. Most endoscopists use the tissue obtained from the ulcer margins for histopathological examination and detection of H. pylori infection in patients with gastric ulcer. Whether this is suitable deserves study. Methodology: A total of 103 consecutive subjects with gastric ulcer were recruited. Biopsy specimens from the margins of gastric ulcer were sent for histological examination with modified Giemsa stain. Two biopsy specimens from the antrum and greater curvature site of mid body were embedded in rapid urease test (CLOtest). A patient was classified as H. pylori positive if either CLOtest or histology were positive. Results: 57 patients had H. pylori infection. The detection rate of rapid urease test and histological examination was 96.5% (55/57) and 59.6% (35/57), respectively. Of the 3 patients who had positive histological examinations and negative urease test, only one was confirmed again to have H. pylori infection. The detection rates of rapid urease test and histological examination in different locations of ulcer (antrum/angularis/proximal stomach) were 92.6%/100%/100% and 81.5%/42.1%/36.4%, respectively. Conclusions: Our study shows that rapid urease test has higher detection rate than histological examination of the biopsy specimens obtained from the margins of gastric ulcer in diagnosis of H. pylori infection. Under the consideration of the health insurance payments limitation and elimination of false-negative detection rate of H. pylori infection, we strongly recommend the rapid urease test from the antrum and body specimens rather than from the ulcer margins for detection of the bacteria in patients with gastric ulcer disease.