Rapid urease test is less sensitive than histology in diagnosing Helicobacter pylori infection in patients with non-variceal upper gastrointestinal bleeding

Background and Aims: The validity of the rapid urease (CLO) test to diagnos e Helicobacter pylori infection in patients with bleeding ulcers has been q uestioned. The aim of this paper is to evaluate the validity of the CLO tes t in comparison with histology in diagnosing H. pylori infection in patient s with acute upper gastrointestinal bleeding (UGB), irrespective of non-ste roidal anti-inflammatory drug (NSAID) use. Methods: Upper gastrointestinal endoscopy was performed within 24 h of admi ssion for all patients with UGB admitted to the Department of Pathophysiolo gy, Medical School, Athens, for a period of 12 months. Patients with varice al bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication t herapy were excluded from the study. At least four biopsies (two from the a ntrum and two from the body) were obtained for the CLO test and histology ( modified Giemsa). Results: Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 wom en) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, w hile 44 patients (61%) were found to be positive on histology (P < 0.045, 9 5% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 6 8 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not inflence results of either the CLO or histology. Conclusions: The CLO test, performed within 24 h of hospital admission in p atients with UGB, irrespective of NSAID use, is unreliable for the detectio n of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results. (C) 2000 Blackwell S cience Asia Pty Ltd.