Comparison of diagnostic methods for Helicobacter pylori infection in patients with upper gastrointestinal bleeding

Background: Accuracy of the most frequently used tests for diagnosing Helic obacter pylori infection in patients with upper gastrointestinal bleeding o f peptic origin is determined. Methods: Seventy-eight patients with endosco pically-proven upper gastrointestinal bleeding of peptic origin were includ ed. The presence of H. pylori was considered when observed from the histolo gy or, if negative, when serology and breath test were both positive. Accur acy of the rapid urease test was estimated in accordance with results obtai ned with other diagnostic methods. Results: Lesions causing gastrointestina l bleeding were 56 duodenal ulcers, 13 gastric ulcers, 7 pyloric channel ul cers, 13 acute lesions of the gastric mucosa and 16 erosive duodenitis. H. pylori infection was present in 68 patients (87.2%). Forty-four patients ha d received non-steroidal anti-inflammatory drugs. The sensitivity/specifici ty (%) of the diagnostic methods was 48.5/100 for the rapid urease test, 91 /77.8 for the breath test, 89.5/80 for serology and 86.3/100 for histology. The prior consumption of proton-pump inhibitors and antibiotics induced fa lse-negative results in the rapid urease test and breath test, with no effe ct on serology and histology. Conclusions: The prevalence of H. pylori infe ction in patients with upper gastrointestinal bleeding from peptic lesions is high. Sensitivity of the rapid urease test for diagnosing H. pylori is l ow in this setting. Cases with negative rapid urease test need the combinat ion of two or more additional tests if diagnosis is to be achieved. Cases w ith positive rapid urease test do not need further investigation for diagno sis.