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Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of helicobacter pylori

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World Journal of Gastroenterology 2023年第10期29卷 1638-1647页

作者： Riccardo Vasapolli Florent Ailloud Sebastian Suerbaum Jens Neumann Nadine Koch Lukas Macke Jörg Schirra Julia Mayerle Peter Malfertheiner Christian Schulz Medical DepartmentⅡ University Hospital LMU MunichMunich 81377Germany Deutsches Zentrum für Infektionsforschung Partner Site MunichMunich 81377Germany Max von Pettenkofer Institute Faculty of MedicineLudwig-Maximilians University of MunichMunich 80336Germany National Reference Center for helicobacter pylori Munich 81377Germany Institute of Pathology Faculty of MedicineLudwig-Maximilians-University of MunichMunich 81377Germany

BACKGROUND Endofaster is an innovative technology that can be combined with upper gastrointestinal endoscopy(UGE)to perform gastric juice analysis and real-time detection of helicobacter pylori(H.pylori).AIM To assess the diagnostic performance of this technology and its impact on the management of H.pylori in the real-life clinical setting.METHODS Patients undergoing routine UGE were prospectively recruited.Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test(RUT).Gastric juice sampling and analysis was performed using the Endofaster,and the diagnosis of H.pylori was based on real-time ammonium measurements.Histological detection of H.pylori served as the diagnostic gold standard for comparing Endofaster-based H.pylori diagnosis with RUT-based H.pylori detection.RESULTS A total of 198 patients were prospectively enrolled in an H.pylori diagnostic study by Endofasterbased gastric juice analysis(EGJA)during the UGE.Biopsies for RUT and histological assessment were performed on 161 patients(82 men and 79 women,mean age 54.8±19.2 years).H.pylori infection was detected by histology in 47(29.2%)patients.Overall,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value(NPV)for H.pylori diagnosis by EGJA were 91.5%,93.0%,92.6%,84.3%,and 96.4%,respectively.In patients on treatment with proton pump inhibitors,diagnostic sensitivity was reduced by 27.3%,while specificity and NPV were unaffected.EGJA and RUT were comparable in diagnostic performance and highly concordant in H.pylori detection(κ-value=0.85).CONCLUSION Endofaster allows for rapid and highly accurate detection of H.pylori during gastroscopy.This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.

关键词： helicobacter pylori diagnostic Chronic gastritis Gastric juice Endofaster Rapid urease test Antimicrobial susceptibility testing

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