Diagnostic accuracy of rapid urease test for the diagnosis of helicobacter pylori in gastric biopsies in Nigerians with dyspepsia

African Journal of Clinical and Experimental Microbiology 01/2010; DOI: 10.4314/ajcem.v12i2.64318


Background: The strong association of Helicobacter pylori (H. pylori) with dyspepsia has caused a major paradigm shift in patients’ management. It has been observed that histology is usually employed as the routine test for the diagnosing H. pylori in centres where Oesophagogastroduodenoscopy (OGD) is available in Nigeria. Because of the drawbacks attendant to the use of histology, in terms of cost effectiveness and technical expertise, it is necessary to evaluate the diagnostic accuracy of a simpler alternative for ease of management of patients with dyspepsia.
Objective: This study evaluated the diagnostic accuracy of rapid urease test (RUT) in the diagnosis of Helicobacter pylori (H. pylori) in patients with dyspepsia.
Methods: Eighty-six consecutive adult patients with dyspeptic symptoms presenting for endoscopy were recruited after giving informed consent. Gastric antral biopsies were collected at endoscopy for RUT and histology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of RUT was calculated using histology as the reference standard.
Results: Of the 86 subjects, there were 39 (45.3%) males and 47(54.7%) females. The mean age was 49.19±13.75 years. The age range was 23 to 85 years. The sensitivity, specificity, PPV, NPV of RUT was 93.33%, 75.6 %, 80.76 %, and 91.17 % respectively.
Conclusion: RUT is accurate for the diagnosis of H. pylori infection. Its use will serve as a good alternative to histology in management of patients with dyspepsia in resource poor environments, except in patients who need histology for reasons other than H. Pylori diagnosis.

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Available from: Jesse A Otegbayo, Dec 11, 2014
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    ABSTRACT: To evaluate Helicobacter pylori (H. pylori) detection by histological staining methods, and to compare with those of Gram staining and polymerase chain reaction (PCR). This is a cross-sectional study conducted at the Department of Microbiology, Shree P. M. Patel Paramedical College, Anand, Gujarat, India on 436 patients attending the Deep Surgical Hospital, Anand, Gujarat between February 2008 and October 2011. Biopsies were subjected to histological staining using Hematoxylin & Eosin (H&E), Giemsa, and Warthin-Starry stains, as well as with Gram staining. The PCR was performed on 71 biopsy samples. Sensitivity and negative predictive values of all 3 histological stains (Warthin-Starry, H&E, and Giemsa) were excellent. Gram staining showed excellent results pertaining to sensitivity, specificity, positive predictive value, and accuracy. Sensitivity of PCR was remarkably low compared to all the staining methods. The sensitivity of all histological stains was found better than PCR. From the findings in our study, we conclude that in a mediocre laboratory, where PCR facility is not available, histological stain can be a better substitute for the diagnosis of H. pylori. Our findings also confirm the assertion that Gram staining is a preferred stain, affordable, reliable, and simple means for identifying H. pylori compared with both histology and PCR.
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