Laine Loren A, Nathwani Rahul A, Naritoku Wesley
GI Division, Department of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Gastrointest Endosc. 2005 Dec;62(6):853-9. doi: 10.1016/j.gie.2005.09.019.
Some case series and cohort studies suggest that acute GI bleeding decreases the sensitivity of Helicobacter pylori diagnostic testing.
To assess H pylori biopsy testing in patients with acute upper-GI bleeding and 1 month later.
Prospective cohort study using patients as their own controls.
Urban county hospital.
Sixty-one patients with acute variceal bleeding.
Antral and body endoscopic biopsies at admission and 1 month later.
CLOtest and histologic examinations were performed and biopsy specimens were coded and mixed for blinded histologic examination for H pylori density and inflammation.
CLOtest results changed from H pylori negative at baseline to H pylori positive at 1 month in two patients (3%), from H pylori positive to H pylori negative in 6 patients (10%), and remained the same in 53 (87%). Histologic results changed from H pylori negative at baseline to H pylori positive at 1 month in two patients (3%), from H pylori positive to H pylori negative in 5 patients (8%), and remained the same in 54 (89%). Changes occurred only in patients with low H pylori density. No significant increase in H pylori density or change in inflammatory cell infiltration was seen. CLOtest sensitivity was 8% higher with bleeding vs. 1 month after bleeding (79% vs. 71%; 95% CI of difference was -11% to 27%; i.e., maximal potential decrease in sensitivity with bleeding is 11%).
The population is not one for which H pylori testing is recommended, and biopsy test performance was less consistent than expected.
Acute-GI bleeding did not decrease the sensitivity of rapid urease testing, unless the effect lasts more than 1 month. Furthermore, bleeding did not produce falsely negative histologic examinations for H pylori, decrease H pylori density, or alter inflammatory cell infiltration. However, given the lower than expected overall CLOtest sensitivity and frequent use of proton pump inhibitors for GI bleeding, histology may be preferred in this setting.
一些病例系列研究和队列研究表明，急性胃肠道出血会降低幽门螺杆菌诊断检测的敏感性。
评估急性上消化道出血患者及其出血1个月后的幽门螺杆菌活检检测情况。
以前瞻性队列研究，以患者自身作为对照。
城市县级医院。
61例急性静脉曲张出血患者。
入院时及1个月后进行胃窦和胃体内镜活检。
进行CLO检测和组织学检查，活检标本进行编码并混合，以便对幽门螺杆菌密度和炎症进行盲法组织学检查。
CLO检测结果显示，2例患者（3%）从基线时幽门螺杆菌阴性变为1个月时幽门螺杆菌阳性，6例患者（10%）从幽门螺杆菌阳性变为阴性，53例患者（87%）保持不变。组织学结果显示，2例患者（3%）从基线时幽门螺杆菌阴性变为1个月时幽门螺杆菌阳性，5例患者（8%）从幽门螺杆菌阳性变为阴性，54例患者（89%）保持不变。变化仅发生在幽门螺杆菌密度较低的患者中。未观察到幽门螺杆菌密度显著增加或炎症细胞浸润变化。出血时CLO检测敏感性比出血1个月后高8%（79%对71%；差异的95%置信区间为-11%至27%；即出血时敏感性的最大潜在降低为11%）。
该人群并非推荐进行幽门螺杆菌检测的人群，活检检测性能不如预期一致。
急性胃肠道出血并未降低快速尿素酶检测的敏感性，除非这种影响持续超过1个月。此外，出血并未导致幽门螺杆菌组织学检查出现假阴性、降低幽门螺杆菌密度或改变炎症细胞浸润。然而，鉴于CLO检测总体敏感性低于预期，且胃肠道出血时经常使用质子泵抑制剂，在这种情况下组织学检查可能更受青睐。
