Abstract：
OBJECTIVE: Histopathology is the most accurate test to detect H. pylori when performed correctly with unknown validity in daily practice clinic settings. We aimed to determine the rate of potentially false-negative H. pylori results that might be due to continued use of proton pump inhibitors (PPIs) in routine endoscopy practice. We also aimed to establish whether gastroenterologists recommend routine cessation of PPIs before esophagogastroduodenoscopy (EGD) and whether they regularly document that biopsies for H. pylori testing have been taken while the patients are on PPI treatment.
METHODS: Detailed information about three known factors (PPIs, antibiotics and prior H. pylori eradication treatment), which may cause histology or rapid urease test (RUT) to be unreliable, had been prospectively collected through interviews using a questionnaire before each test. Gastric biopsies were stained with H&E for histological analysis.
RESULTS: A total of 409 individuals at three academic gastroenterology institutions were tested 200 times with histology. Fifty-six per cent (68 of 122) of all negative tests fell in the category of continuing PPI use, which had the potential to make the histology and RUT results unreliable.
CONCLUSIONS: These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the diagnosis of H. pylori during EGD. A negative histology or RUT should be considered false negative until potential protocol violations are excluded. Documentation of PPI use during the EGD should be an integral part of the EGD report. The current practice of taking biopsies for H. pylori testing in patients under PPIs should be reevaluated.
METHODS: Detailed information about three known factors (PPIs, antibiotics and prior H. pylori eradication treatment), which may cause histology or rapid urease test (RUT) to be unreliable, had been prospectively collected through interviews using a questionnaire before each test. Gastric biopsies were stained with H&E for histological analysis.
RESULTS: A total of 409 individuals at three academic gastroenterology institutions were tested 200 times with histology. Fifty-six per cent (68 of 122) of all negative tests fell in the category of continuing PPI use, which had the potential to make the histology and RUT results unreliable.
CONCLUSIONS: These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the diagnosis of H. pylori during EGD. A negative histology or RUT should be considered false negative until potential protocol violations are excluded. Documentation of PPI use during the EGD should be an integral part of the EGD report. The current practice of taking biopsies for H. pylori testing in patients under PPIs should be reevaluated.
摘要：
目的：组织病理学是检测幽门螺杆菌的最准确的检测方法，在日常诊所设置中正确进行，有效性未知。我们旨在确定可能是由于在常规内窥镜检查实践中继续使用质子泵抑制剂（PPI）所致的幽门螺杆菌假阴性结果的发生率。我们还旨在确定胃肠病学家是否建议在食管胃十二指肠镜检查（EGD）之前常规停止PPI，以及他们是否定期记录在患者接受PPI治疗期间进行了幽门螺杆菌活检。
方法：关于三个已知因素的详细信息（PPI，抗生素和先前的幽门螺杆菌根除治疗)，这可能导致组织学或快速脲酶测试（RUT）不可靠，在每次测试之前，通过使用问卷的访谈前瞻性地收集。胃活检用H&E染色用于组织学分析。
结果：三个学术胃肠病学机构共409名个体接受了200次组织学检查。在所有负面测试中，有56％（122个中的68个）属于继续使用PPI的类别，这有可能使组织学和RUT结果不可靠。
结论：这些数据表明，在EGD期间幽门螺杆菌的诊断方面，当前指南与现实实践之间存在明显而重要的差距。组织学或RUT阴性应视为假阴性，直到排除潜在的协议违规。EGD期间使用PPI的文件应成为EGD报告的组成部分。应该重新评估目前对PPI患者进行活检以进行幽门螺杆菌检测的做法。
方法：关于三个已知因素的详细信息（PPI，抗生素和先前的幽门螺杆菌根除治疗)，这可能导致组织学或快速脲酶测试（RUT）不可靠，在每次测试之前，通过使用问卷的访谈前瞻性地收集。胃活检用H&E染色用于组织学分析。
结果：三个学术胃肠病学机构共409名个体接受了200次组织学检查。在所有负面测试中，有56％（122个中的68个）属于继续使用PPI的类别，这有可能使组织学和RUT结果不可靠。
结论：这些数据表明，在EGD期间幽门螺杆菌的诊断方面，当前指南与现实实践之间存在明显而重要的差距。组织学或RUT阴性应视为假阴性，直到排除潜在的协议违规。EGD期间使用PPI的文件应成为EGD报告的组成部分。应该重新评估目前对PPI患者进行活检以进行幽门螺杆菌检测的做法。
