THE VALUE OF DIFFERENT DETECTION METHODS OF HELICOBACTER-PYLORI DURING TREATMENT

It has been suggested that profound acid inhibition by proton pump inh ibitors affects the accuracy of H. pylori detection. This report aims to evaluate H. pylori status during treatment with four different inva sive detection methods and to investigate if histopathological alterat ions during treatment can be used as an early marker for H. pylori era dication. Twenty-eight H, pylori-positive patients were studied random ized into two treatment groups: 14 patients received omeprazole, 20 mg plus amoxicillin 1,000 mg b.i.d (OA), and 14 patients received omepra zole, 20 mg and placebo b.i.d (OP) for 14 days. Biopsies from antrum a nd corpus of the stomach were collected on days 0, 10 and 42. H. pylor i status was based on rapid urease test, cultivation, histology, and p olymerase chain reaction (PCR). The biopsies were also graded accordin g to the Sidney classification, In the OP and the OA group, 17% (2/12) and 92% (12/13) of the patients were H. pylori negative when tested d uring treatment (day 10), Four weeks after treatment none of the patie nts (0%) in the OP group and 61% (8/13) in the OA group had their H. p ylori infection eradicated. PCR was up to 34% more sensitive than the other tests to detect H, pylori during treatment. There was a decrease in histological inflammation and activity ill the antrum already duri ng treatment in the OA group, but the decrease did not discriminate fo r successful treatment. During treatment with omeprazole alone or in c ombination with amoxicillin, H. pylori detection is impaired regardles s of the detection method used. However, PCR appears to be more sensit ive than other tests. Early changes in the histological appearance of the gastric mucosa do not predict H. pylori treatment outcome.