Testing ofHelicobacter pyloriby Endoscopic Biopsy: The Clinical Dilemma of Suppressive Conditions

Background and Aims:Testing forHelicobacter pyloriis frequently conducted during esophagogastroduodenoscopy (EGD). Suppressive conditions such as the intake of proton-pump inhibitors (PPIs), preceded antibiotic treatment or recent upper gastrointestinal bleeding impairH. pyloritest quality. The aim of our study was to evaluate the frequency and pattern ofH. pylorisuppressive conditions in a large patient collective undergoing elective EGD in a German university hospital.Methods:The trial was performed as a single-center study. Only elective EGD from inpatients and outpatients were included. Prior to endoscopy,H. pylorisuppressive conditions were collected using a standardized questionnaire. IfH. pyloritesting was indicated according to the guidelines, always both histology and helicobacter urease test were performed in analogy to the Sydney classification.Results:One thousand six hundred and thirty-one patients were included (median 61 years, 36.0% outpatients, 64.0% inpatients). Overall, 76.5% of patients were underH. pylorisuppressive conditions. The main suppressive condition was the intake of PPIs (70.7%). In 819 (50.2%) of all included cases,H. pyloritesting was performed. The following were the results: 17.3% (142) had a positiveH. pyloritesting and 82.7% (677) were negative. Of those with negative result, 70.0% were tested under suppressive conditions.Conclusion:Guidelines recommendH. pyloritesting under non-suppressive conditions. However, this does not always meet the clinical practice. Our data show that de facto, many patients undergoing elective EGD are tested forH. pyloriunder suppressive conditions coming along with a higher risk of potentially false negative results. Particularly, concerning this issue, further research is needed to improve and clarify everyday clinical practice.