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Performances diagnostiques du test rapide à l’uréase dans la détection de l’infection à Helicobacter pylori en période hémorragique

Accuracy of rapid urease test in the diagnosis of H. pylori during bleeding period

  • Article Original / Original Article
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Acta Endoscopica

Résumé

Introduction

Le test rapide à l’uréase (TRU) est considéré comme l’un des moyens diagnostiques de première ligne de l’infection à Helicobacter pylori chez les patients bénéficiant d’une endoscopie haute, et cela grâce à sa grande spécificité et sensibilité, son coût et sa reproductibilité par rapport à l’étude histologique. Cependant, un grand nombre d’études suggèrent que la sensibilité du TRU diminue significativement chez les patients présentant un ulcère gastroduodénal hémorragique. Le but de notre étude était d’évaluer les performances diagnostiques du TRU dans le diagnostic de l’infection à H. pylori dans l’ulcère bulbaire en période hémorragique.

Matériels et méthodes

Notre travail est une étude prospective de type transversal portant sur des patients hospitalisés pour ulcère bulbaire hémorragique, conduite au sein du service d’hépatogastroentérologie du CHU Hassan-II, étalée sur une période de deux ans et trois mois. Tous les malades inclus dans l’étude ont bénéficié de biopsies antrales avec recherche de l’infection à H. pylori au TRU et à l’histologie considérée comme gold standard.

Résultats

Cent seize patients porteurs d’ulcère bulbaire hémorragique étaient inclus. La sensibilité du TRU était de 72 % avec une valeur prédictive négative de 30 %, une spécificité de 88 % et une valeur prédictive positive de 97 %. La présence de sang dans l’estomac et la consommation des AINS étaient les principaux facteurs diminuant la sensibilité de ce test rapide.

Conclusion

Le TRU reste un test couramment utilisé en pratique pour le diagnostic de l’infection à H. pylori du fait de ces performances. En période hémorragique, la sensibilité du TRU diminue en présence de sang dans l’estomac et de la consommation d’AINS.

Abstract

Introduction

The rapid urease test is considered one of the primary diagnostics of Helicobacter pylori infection among patients undergoing upper endoscopy and thanks to its high sensitivity and specificity, cost and reproducibility compared with the histological study. However, many studies suggest that the sensitivity of rapid urease test decreased significantly in patients with bleeding peptic ulcer. The aim of our study is to evaluate the diagnostic performance of rapid urease test in the diagnosis of H. pylori infection in peptic ulcer during bleeding complication.

Materials and methods

Our work is a prospective study on patients hospitalized for bleeding peptic ulcer, conducted at the hepatogastroenterology unit of University Hospital Hassan II over a period of two years and three months. All patients included in the study have benefited from antral biopsies with search of H. pylori infection in rapid urease test (CLOtest) and histology.

Results

One hundred and sixteen patients with bleeding peptic ulcer were admitted during this period. The sensitivity of rapid urease test was 72% with a negative predictive value of 30%, specificity of 88% and positive predictive value of 97%. The presence of blood in the stomach and the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) were the major factors that decrease the sensitivity of this rapid test.

Conclusion

The rapid urease test is a test commonly used in practice for the diagnosis of H. pylori infection. Acute bleeding may be responsible for many false negatives due to the presence of blood in stomach and NSAIDs.

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Références

  1. Jordi SD, Gené E, Suárez D, García-Iglesias P, Brullet E, Gallach M, et al. Has H. pylori prevalence in bleeding peptic ulcer been underestimated? A meta-regression. Am J Gastroenterol 2011;106:398–405.

    Article  Google Scholar 

  2. Hernandez R, Ontiveros EL, Almaraz Larreta A, Ramirez NJ, Ramirez S, Karam JS. Peptic ulcer with hemorrhage. An analysis of hospital discharges. Rev Gastroenterol Mex 1999;64:6–11.

    Google Scholar 

  3. Adamopoulos AB, Efstathiou SP, Tsioulos DI, Tzamouranis DG, Tsiakou AG, Tiniakos D, et al. Bleeding duodenal ulcer: comparison between Helicobacter pylori positive and Helicobacter pylori negative bleeders. Dig Liver Dis 2004;36:13–20.

    Article  PubMed  CAS  Google Scholar 

  4. Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994;331:717–727.

    Article  PubMed  CAS  Google Scholar 

  5. Mignon M, Penston JG, Deltenre M, Ruszniewski P, Dobrill G. Natural history of duodenal ulcer disease: are we at a turning point? Gastroenterol Int 1994;7:95–113.

    Google Scholar 

  6. Gisbert JP, Calvet X, Feu F, Bory F, Cosme A, Almela P, et al. Eradication of Helicobacter pylori for the prevention of peptic ulcer rebleeding. Helicobacter 2007;12:279–286.

    Article  PubMed  Google Scholar 

  7. Javier P, Gisbert P, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcers: a systematic review and meta-analysis. Am J Gastroenterol 2006;101:848–863.

    Article  Google Scholar 

  8. Tang JH, Liu NJ, Cheng HT, Lee CS, Chu YY, Sung KF, et al. Endoscopic diagnosis of Helicobacter pylori infection by rapid urease test in bleeding peptic ulcers: a prospective case-control study. J Clin Gastroenterol 2009;43:133–139.

    Article  PubMed  Google Scholar 

  9. Stanciu C, Trifan A, Mihailovici S, Cojocariu C. Endoscopic diagnosis of Helicobacter pylori in patients with bleeding peptic ulcers. Rev Med Chir Soc Med Nat Iasi 2007;111:57–64.

    PubMed  CAS  Google Scholar 

  10. Zagari RM, Bazzoli F. Helicobacter pylori testing in patients with peptic ulcer bleeding. Dig Liver Dis 2003;35:215–216.

    Article  PubMed  CAS  Google Scholar 

  11. Aquino F, Montes P, Monge E. Acute upper GI bleeding does not decrease the diagnostic yield of gastric biopsies for Helicobacter pylori infection. Gastrointest Endosc 2006;63:889.

    Article  PubMed  Google Scholar 

  12. Laine AL, Nathwani RA, Naritoku W. The effect of GI bleeding on Helicobacter pylori diagnostic testing: a prospective study at the time of bleeding and 1 month later. Gastrointest Endosc 2005;62:853–859.

    Article  PubMed  Google Scholar 

  13. Zagari RM, Bazzoli F. Helicobacter pylori testing in patients with peptic ulcer bleeding. Dig Liver Dis 2003;23:215–216.

    Article  Google Scholar 

  14. Colin R, Czernichow P, Baty V, Touzé I, Brazier F, Bretagne JF, et al. Low sensitivity of invasive tests for the detection of Helicobacter pylori infection in patients with bleeding ulcer. Gastroenterol Clin Biol 2000;24:31–35.

    PubMed  CAS  Google Scholar 

  15. Lee JM, Breslin MB. Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding. Am J Gastroenterol 2000;95:1166–1170.

    Article  PubMed  CAS  Google Scholar 

  16. Tu TC, Lee CL, Wu CH, Chen TK, Chan CC, Huang SH, et al. Comparison of invasive and noninvasive tests for detecting Helicobacter pylori infection in bleeding peptic ulcers. Gastrointest Endosc 1999;49:302–306.

    Article  PubMed  CAS  Google Scholar 

  17. Grino P, Pascual S, Such J, Casellas JA, Niveiro M, Andreu M, et al. Comparison of diagnostic methods for Helicobacter pylori infection in patients with upper gastrointestinal bleeding. Scand J Gastroenterol 2001;36:1254–1258.

    Article  PubMed  CAS  Google Scholar 

  18. Lin HJ, Lo WC, Perng CL, Fen-Yau Li A, Tseng GL, Sun IL, et al. Helicobacter pylori stool antigen test in patients with bleeding peptic ulcers. Helicobacter 2004;9:663–668.

    Article  PubMed  Google Scholar 

  19. Archimandritis A, Tzivras M, Sougioultzis S, Apostolopoulos P, Avlami A, Davaris PS. Rapid urease test is less sensitive than histology in diagnosing Helicobacter pylori infection in patients with non variceal upper gastrointestinal bleeding. J Gastroenterol Hepatol 2000;15:369–373.

    Article  PubMed  CAS  Google Scholar 

  20. Schilling D, Demel A, Adamek HE, Weidmann E, Riemann JF. A negative rapid urease test in unreliable for exclusion of Helicobacter pylori infection during acute phase of ulcer bleeding. Dig Liver Dis 2003;35:217–221.

    Article  PubMed  CAS  Google Scholar 

  21. Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection the Maastricht III consensus report. Gut 2007;56:772–781.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Service de gastroentérologie, CHU Hassan-II, route Sidi-Hrazem, 30000, Fès, Maroc

    N. Lahmidani, M. ElYousfi, I. Mellouki, M. ElAbkari, A. Ibrahimi & D. Benajah

  2. Service hépatogastroentérologie, CHU Hassan-II, route Sidi-Hrazem, 30000, Fès, Maroc

    N. Aqodad

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  1. N. Lahmidani
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  2. N. Aqodad
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  3. M. ElYousfi
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  4. I. Mellouki
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  5. M. ElAbkari
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Correspondence to N. Lahmidani.

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Lahmidani, N., Aqodad, N., ElYousfi, M. et al. Performances diagnostiques du test rapide à l’uréase dans la détection de l’infection à Helicobacter pylori en période hémorragique. Acta Endosc 43, 14–18 (2013). https://doi.org/10.1007/s10190-013-0300-2

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  • DOI: https://doi.org/10.1007/s10190-013-0300-2

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