Work

Diagnostic Performance of 6 Tests for Helicobacter pylori Infection in Peptic Ulcer Bleeding: A Prospective Head-to-Head Comparison

Year: 2026

Type: article

Abstract: INTRODUCTION: Rapid urease test (RUT) is widely used for diagnosing Helicobacter pylori (HP) because it is inexpensive and practical. However, its accuracy is reduced in peptic ulcer bleeding (PUB). We prospectively performed a head-to-head comparison of diagnostic tests in the same patients to evaluate their performance in this setting. METHODS: After endoscopic hemostasis, gastric biopsies were obtained for RUT, histology, and polymerase chain reaction (PCR). Blood samples were collected for current infection marker and antiurease antibody. Urea breath testing (UBT) was performed in patients with negative RUT and histology. Diagnostic performance was assessed using a composite reference standard defined by at least 2 positive results among RUT, histology, PCR, and UBT. Logistic regression was used to identify factors associated with false-negative RUT. RESULTS: A total of 135 patients with PUB were enrolled, of whom 36 (26.7%) were HP-positive. Sensitivity/specificity was 69.4%/97.0% for RUT, 55.6%/96.0% for histology, 97.2%/92.9% for PCR, 77.8%/77.8% for current infection marker, and 83.3%/62.6% for antiurease antibody. Combining RUT, histology, and either PCR or UBT increased sensitivity to 100% and significantly outperformed RUT alone ( P = 0.021 and P = 0.001, respectively). PCR reduced idiopathic ulcers from 31.9% to 26.7%. Only 43 of 98 patients with negative RUT and histology underwent UBT because of clinical constraints, limiting its practicality despite excellent performance. No predictors of false-negative RUT were identified. DISCUSSION: In PUB, tissue PCR showed the best overall diagnostic performance among the single tests. RUT alone is insufficient for diagnosing HP, whereas combined testing with RUT, histology, and PCR or UBT achieved the highest diagnostic performance.

Source: Clinical and Translational Gastroenterology

DOI: 10.14309/ctg.0000000000001087

Authors: Tanawat Geeratragool, Thanapat Atthakitmongkol, Supathep Tansirichaiya, Pubet Weeranawin, Somchai Leelakusolvong, Monthira Maneerattanaporn

Institutions: Siriraj Hospital, Mahidol University

Language: English

Topic: Helicobacter pylori-related gastroenterology studies

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,800