Background and Aims: Testing for Helicobacter pylori is frequently conducted during esophagogastroduodenoscopy (EGD). Suppressive conditions such as the intake of proton-pump inhibitors (PPIs), preceded antibiotic treatment or recent upper gastrointestinal bleeding impair H. pylori test quality. The aim of our study was to evaluate the frequency and pattern of H. pylori suppressive 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. pylori suppressive conditions were collected using a standardized questionnaire. If H. pylori testing 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 under H. pylori suppressive conditions. The main suppressive condition was the intake of PPIs (70.7%). In 819 (50.2%) of all included cases, H. pylori testing was performed. The following were the results: 17.3% (142) had a positive H. pylori testing and 82.7% (677) were negative. Of those with negative result, 70.0% were tested under suppressive conditions. Conclusion: Guidelines recommend H. pylori testing 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 for H. pylori under 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.

Journal Section:
Research Article
Keywords:
Helicobacter pylori, Helicobacter pylori suppressive conditions, Esophagogastroduodenoscopy, Helicobacter urease test, Proton-pump inhibitors, Upper gastrointestinal bleeding, Helicobacter pylori eradication
1.
Fischbach W, Malfertheiner P, Lynen Jansen P, Bolten W, Bornschein J, Buderus S, et al.; Verantwortlich für die DGVS. [S2k-guideline Helicobacter pylori and gastroduodenal ulcer disease]. Z Gastroenterol. 2016 Apr;54(4):327–63.
2.
Malfertheiner P, Link A, Selgrad M. Helicobacter pylori: perspectives and time trends. Nat Rev Gastroenterol Hepatol. 2014 Oct;11(10):628–38.
3.
Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009 Oct;374(9699):1449–61.
4.
Peleteiro B, Bastos A, Ferro A, Lunet N. Prevalence of Helicobacter pylori infection worldwide: a systematic review of studies with national coverage. Dig Dis Sci. 2014 Aug;59(8):1698–709.
5.
Fischbach W, Malfertheiner P. Helicobacter Pylori Infection. Dtsch Arztebl Int. 2018 Jun;115(25):429–36.
6.
Wex T, Venerito M, Kreutzer J, Götze T, Kandulski A, Malfertheiner P. Serological prevalence of Helicobacter pylori infection in Saxony-Anhalt, Germany, in 2010. Clin Vaccine Immunol. 2011 Dec;18(12):2109–12.
7.
Michel A, Pawlita M, Boeing H, Gissmann L, Waterboer T. Helicobacter pylori antibody patterns in Germany: a cross-sectional population study. Gut Pathog. 2014 Apr;6(1):10.
8.
Porsch-Ozcürümez M, Doppl W, Hardt PD, Schnell-Kretschmer H, Tuncay M, Akinci A, et al. Impact of migration on Helicobacter pylori seroprevalence in the offspring of Turkish immigrants in Germany. Turk J Pediatr. 2003 Jul-Sep;45(3):203–8.
9.
Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984 Jun;1(8390):1311–5.
10.
Talebi Bezmin Abadi A. Diagnosis of Helicobacter pylori Using Invasive and Noninvasive Approaches. J Pathogens. 2018 May;2018:9064952.
11.
Marshall BJ, Warren JR, Francis GJ, Langton SR, Goodwin CS, Blincow ED. Rapid urease test in the management of Campylobacter pyloridis-associated gastritis. Am J Gastroenterol. 1987 Mar;82(3):200–10.
12.
Cutler AF, Havstad S, Ma CK, Blaser MJ, Perez-Perez GI, Schubert TT. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995 Jul;109(1):136–41.
13.
Best LM, Takwoingi Y, Siddique S, Selladurai A, Gandhi A, Low B, et al. Non-invasive diagnostic tests for Helicobacter pylori infection. Cochrane Database Syst Rev. 2018 Mar;3:CD012080.
14.
Bezmin Abadi AT, Taghvaei T, Wolfram L. Inefficiency of rapid urease test for confirmation of Helicobacter pylori. Saudi J Gastroenterol. 2011 Jan-Feb;17(1):84–5.
15.
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017 Feb;112(2):212–39.
16.
Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al.; European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017 Jan;66(1):6–30.
17.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996 Oct;20(10):1161–81.
18.
Fischbach W, Malfertheiner P, Hoffmann JC, Bolten W, Bornschein J, Götze O, et al.; German society for hygiene and microbiology; German society for pediatric gastroenterology and nutrition e. V; German society for rheumatology. S3-guideline “helicobacter pylori and gastroduodenal ulcer disease” of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e. V., German society for rheumatology, AWMF-registration-no. 021 / 001. Z Gastroenterol. 2009 Dec;47(12):1230–63.
19.
Guidelines for clinical trials in Helicobacter pylori infection. Working Party of the European Helicobacter pylori Study Group. Gut. 1997 Sep;41 Suppl 2:S1–9.
20.
Mégraud F, Lehours P. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Rev. 2007 Apr;20(2):280–322.
21.
Shirin D, Matalon S, Avidan B, Broide E, Shirin H. Real-world Helicobacter pylori diagnosis in patients referred for esophagoduodenoscopy: the gap between guidelines and clinical practice. United European Gastroenterol J. 2016 Dec;4(6):762–9.
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