The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting.

BACKGROUND: Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting. METHODS: Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and 13C-UBT tests were performed. RESULTS: Seventeen patients were defined H. pylori positive by 13C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting. CONCLUSIONS: In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in persistent peptic ulcer cases.

Open access endoscopy in an epidemiological situation of high prevalence of Helicobacter pylori infection: applicability of the guidelines of the European Society for Primary Care Gastroenterology.

BACKGROUND: Dyspepsia is a common syndrome and provides primary care physicians with a significant workload. To optimize the management of dyspepsia, several guidelines have been developed. OBJECTIVE: The aim of this study was to determine the incidence of upper gastrointestinal diseases and their relationship to Helicobacter pylori infection in dyspeptic patients referred for upper endoscopy by family physicians, as well as to assess the applicability of the guidelines of the European Society for Primary Care Gastroenterology (ESPCG). METHODS: A total of 168 unselected dyspeptic out-patients (mean age 38 years, range 18-75), 88 male and 80 female, were included. Two biopsies from the antrum and two from the corpus were taken for histological assessment, and one from the antrum and one from the corpus were taken for culture. RESULTS: Half of the patients had clinically significant findings at endoscopy: peptic ulcer which occurred in 35% of the patients under the age of 30 years, in 45% of the patients in the age group 30-44 years and in 36% of the patients over 45 years of age. The prevalence of H. pylori infection in these age groups was 67, 87 and 89%, respectively. Duodenal ulcer was 12 times more common than gastric ulcer. CONCLUSIONS: The overall incidence of upper gastrointestinal disease, especially among young dyspeptic patients, was high compared with that observed in Western countries. The characteristics of dyspeptic patients, consulted in primary care, should be used for adaptation of the ESPCG guidelines to local needs.