Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding

OBJECTIVE: The eradication of Helicobacter pylori (H. pylori) in patients w ith bleeding peptic ulcer disease (PUD) decreases the rate of ulcer rebleed ing. Although all methods for H. pylori diagnosis have been extensively eva luated in uncomplicated PUD the efficacy of the commonly used rapid urease test (RUT) has not been established in patients with bleeding peptic ulcer disease. The aim of this study was to evaluate the efficacy of the RUT (CLO test) in patients with bleeding duodenal ulcers (DUs). METHODS: Consecutive patients with symptoms of upper GI tract hemorrhage an d a DU at the time of endoscopy were evaluated. The presence of H. pylori i nfection was determined by RUT, microbiology, and histology. Consecutive pa tients with uncomplicated DUs were similarly evaluated. The prevalence of H . pylori as determined by the RUT alone was compared to that determined by a combination of all tests in both patient groups. RESULTS: Fifty-five patients with bleeding DUs and 69 with nonbleeding DUs were evaluated. The prevalence of H. pylori in patients presenting with ble eding was 72.7% (95% confidence interval [CI] 61.0-84.5%) and lower than th e prevalence rate of 92.8% (95% CI 86.6-98.8%) in patients with uncomplicat ed PUD (p < 0.05). The prevalence of H. pylori in the bleeding DU group as determined by RUT alone (54.5%) was less than that determined by a combinat ion of all tests (73%) with a false-negative rate of 10 of 40 (25%; 95% CI 11.6-38.4%) (p < 0.05). This false-negative rate was significantly greater than that observed in the group presenting with dyspepsia (1 of 64 [1.6%; 9 5% CI 0-4.6%]) (p < 0.01). CONCLUSIONS: The prevalence of H. pylori is lower in patients with bleeding DUs when compared to patients with uncomplicated DUs. In addition, the sen sitivity and negative predictive value of the RUT is lower in patients pres enting with bleeding, and other methods of H. pylori diagnosis should be us ed in this patient group. (C) 2000 by Am. Coil. of Gastroenterology.