Rapid urease test in the management of Campylobacter pyloridis-associated gastritis.

TLDR

Campylobacter pyloridis colonization of the stomach may cause gastritis and peptic ulceration, and its urease production serves as a marker of infection. This study evaluates the rapid urease test (CLOtest) for detecting C. pyloridis infection in gastric mucosal biopsies. The authors performed 141 endoscopies, taking antral biopsies for culture, histology, and a CLOtest gel assay, and rebiopsied 18 infected patients after antibiotic therapy.

Abstract

Campylobacter pyloridis colonization of the stomach may be an etiological factor in gastritis and peptic ulceration. Campylobacter pyloridis produces large amounts of urease, and the presence of this enzyme in gastric mucosa usually indicates infection with the organism. In this paper we describe the use of a rapid urease test (CLOtest) to detect C. pyloridis infection in gastric mucosal biopsies. In 141 consecutive endoscopy cases, antral biopsies were taken for culture and histology, and an extra biopsy was inserted into the CLOtest gel. There were 79 patients infected with C. pyloridis, 78 of whom were detected by CLOtest: 75% were positive at 20 min, 92% at 3 h, and 98% at 24 h. There were no false positive results. Eighteen infected patients were rebiopsied after a course of amoxycillin and bismuth subcitrate. Active chronic gastritis resolved in eight of nine who were cleared of the organism, but histological gastritis was unchanged in nine patients who were still infected. CLOtest is a simple, sensitive, and highly specific test that enables the endoscopist to diagnose C. pyloridis infection in the endoscopy room. A negative test after antibiotic therapy correlates with clearance of the bacteria and healing of active gastritis.