Patient factors affecting culture of Helicobacter pylori isolated from gastric mucosal specimens

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ABSTRACT

Purpose

Culture is one of the methods used for detecting Helicobacter pylori in the stomach. However, since it is costly, labor-consuming, and in a number of infected subjects gives a false negative result, the procedure is not routinely used. The aim of the study was to analyze some of the factors that may affect the outcome of H. pylori culture from endoscopic gastric mucosal specimens.

Material and Methods

The study was conducted in a group of 265 subjects. The culture of gastric mucosal specimens was verified by urease test and histological examination. If the culture result was not consistent with one or two verifying tests, an additional two tests were used, i.e. H. pylori antigens in stool samples and anti-H. pylori antibodies in blood serum.

Results

In patients infected with H. pylori (at least two positive diagnostic tests), the analysis of factors that may affect the culture outcome revealed that neither age, gender, smoking, history of eradication, endoscopic diagnosis, use of proton pump inhibitors, ultrasonography of the abdomen or chest radiology performed the day before or on the day of gastroscopy, nor preparation for colonoscopy using osmotic fluids 1–2 days prior to gastroscopy had an effect on the culture outcome. Only high activity of gastritis (neutrophil infiltration) and low bacterial load in gastric mucosal specimens as well as drinking alcohol and the use of histamine H2 receptor blockers reduced culture efficacy in infected subjects.

Conclusions

High activity of gastritis, low bacterial load, drinking alcohol and the use of histamine H2 receptor blockers can be the cause of failed H. pylori culture from gastric mucosa in the infected subjects. These factors should be taken into consideration when qualifying patients for the test and interpreting the results.

Section snippets

INTRODUCTION

A number of methods are used to detect H. pylori in endoscopic gastric mucosal specimens. One of them is culture. Since culture is costly and time-consuming procedure, requiring an experienced practitioner, not many microbiology laboratories in Poland perform it. For clinical purposes, the routine diagnosis of H. pylori infection of the stomach involves one or two simpler and cheaper tests (Campylobacter-like organisms test (CLO-test), urea breath test, stool antigen test, histology) [1].

MATERIALS AND METHODS

The study was conducted on a group of 265 patients of both genders, aged 19–79 years, hospitalized in the Department of Internal Medicine and Gastroenterology of the District Hospital due to abdominal complaints. Their final diagnosis was dyspepsia (221 patients), duodenal ulcer (32 patients), and gastric ulcer (12 patients). Exclusion criteria were as follows: taking antibiotics within the last 30 days, drinking alcohol within the last 7 days, and smoking cigarettes in the morning hours prior

RESULTS

The culture of H. pylori was performed in 265 patients, yielding 134 positive and 131 negative outcomes. In 5 culture positive patients, the result of the culture was in total inconsistency with CLO-test and histology. In 13 patients with positive culture, the inconsistency was partial – in 6 patients histology was negative and CLO-test positive whereas in 7 patients CLO-test was negative and histology positive (Tab. 1). In 15 culture negative patients, the culture result was in total

DISCUSSION

In the current study, total consistency of CLO-test and histological examination with positive and negative culture results was noted at 86.7% and 78.0%, respectively. Assuming that positive results in at least 2 tests prove the presence of H. pylori infection, all the positive culture group subjects except one had at least 2 other positive diagnostic tests. In only one patient, the positive result was confirmed by one accessory test, i.e. serological examination. Since culture was not the only

ACKNOWLEDGEMENTS

The study was supported by Medical University of Bialystok, grants no 3-22476 F, 3-22458 F, and 3-22981 F

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