Letter: effect of proton pump inhibitor use on invasive detection ofHelicobacter pylorigastritis
Year: 2015
Type: article
Abstract: We read with interest the original article: ‘Helicobacter-negative gastritis: a distinct entity unrelated to Helicobacter pylori infection’ by Genta et al.1 This is by far the largest study that compares the epidemiologic patterns of Helicobacter pylori (Hp)-positive and Hp-negative gastritis. In this study, among 895 323 patients, 10.6% had Hp gastritis and 1.5% Hp-negative gastritis. Unfortunately, the authors did not mention the acid suppressive therapy status, including proton pump inhibitors (PPI), during the diagnosis of Hp gastritis. In addition to anti-gastric secretion effect, PPIs also have bacteriostatic effects against Hp. Bacterial load decreases, particularly in the antrum, which leads to local changes in the stomach, and may reduce the sensitivity of histological examination for Hp on biopsies taken from recommended sites. This could also cause false-negative results.2 One study demonstrated that, in patients on a PPI, histological evaluation of an antrum biopsy had a sensitivity only of 75%, and a corpus biopsy a sensitivity of 83%.3 It was previously shown that among the PPI users, 50% of the patients with negative histology had positive serology for Hp.2 Real-time PCR detects Hp in more than 2/3 of the histology negative sample, and has been shown to be more sensitive than conventional histologic identification of bacteria or immunohistochemistry.4 Thus, PCR testing should be considered as an alternative for detecting Hp infection in patients on PPI treatment.4 In order to minimise the percentage of false-negative results in patients receiving PPI therapy, a better approach is to discontinue the PPI for at least 2 weeks before the endoscopic tissue sampling which allows the bacteria to repopulate in the stomach and the sensitivity of the test could be raised to an acceptable level. Declaration of personal and funding interests: None.
DOI: 10.1111/apt.13092
Authors: S. Kilincalp, Y. Ustun, H. Akinci, S. Coban, İ. Yüksel
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2092842425