Cardiac biopsy of stomach may improve the detection of H-pylori after dualtherapy

BACKGROUND/AIMS: To determine whether gastric cardia biopsy may improve the detection of Helicobacter pylori (H. pylori) before and after eradication therapy. METHODOLOGY: A total of 150 dyspeptic patients with H. pylori infection com pleting a 2-week course of dual therapy (amoxicillin plus omeprazole) were studied. Endoscopy was carried out at the initial stage and 4 weeks after t he completion of dual therapy. During each endoscopy, gastric biopsies were sampled in order from cardia, lower body, and antrum and stored separately to survey the distribution of H. pylori by histology. RESULTS: Before treatment, 88% (132/150) of the study cases had H. pylori f ound in antrum and 3.3% (5/150) of cases presented with bacteria only in ca rdia. After treatment, 38 cases had failure of dual therapy. The detection rates of H. pylori by biopsies without cardia decreased after the dual ther apy (by antrum only: 88% to 60.5%, p<0.05; antrum and body: 96.7% to 81.6%, p<0.05). In contrast, the incidence of patients with only cardia involveme nt by H. pylori significantly increased from 3.3% (5/150) before to 18.4% ( 7/38) after treatment (p<0.01). Among the 7 patients with H. pylori only in cardia after dual therapy, 3 cases had recurrent dyspepsia during follow-u p because of no further anti H. pylori therapy. Two of these 3 cases disclo sed diffuse bacterial involvement in antrum and body besides cardia; the la st case later had a positive result of urea breath test. CONCLUSIONS: Biopsy obtained from gastric cardia can improve the detection rate of H. pylori especially after dual therapy, which encounters antibioti cs with possible sanctuary sites here. Thus, it will be useful to prevent o ver diagnosis of H. pylori eradication.