Is Real-Time Testing for Helicobacter Pylori and Corpus Atrophy Clinically Useful in 2005?

 

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Introduction

Tucci et al. describe a new approach to the rapid detection of Helicobacter pylori infection and atrophic gastritis [1]. They present details of their new device that automatically and accurately measures both gastric juice ammonia levels and pH. The device is attached directly to the suction channel of the endoscope where it automatically collects and assays the sample and then provides the results verbally while the endoscopic procedure is still in progress. The cost per test (excluding the cost of the device and its maintenance) is low and the reported accuracy was excellent.

Measurements of pH and ammonia in the gastric juice have a long history [2]. Over time they were abandoned for new approaches that provided clinically more useful information. The new device was developed to provide simple and accurate real-time measurements with the thought that this information would be clinically useful in terms of time and cost savings required to arrive at a clinically useful diagnosis. The authors compared the results of their new device with a host of traditional measurements, including the noninvasive urea breath test and H. pylori serology as well as tests based on obtaining samples by endoscopy, including histology and rapid urease testing. They showed that, at least in their population, the results with the new device were superior to those obtained by “routine” histology or the rapid urease test they used. They proposed that their device allowed the reliable detection of atrophic gastritis of the oxyntic mucosa, which was labeled as a “risk-associated condition”. The premise is that endoscopist would receive the information in time to select those patients in whom time-consuming and expensive tests such as gastric mucosal biopsy were warranted, and they propose that targeting testing to the population at risk should result in a savings in terms of time and overall costs.

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D. Y. Graham, M. D.

Digestive Diseases Section (111D) · RM 3A-320 · Michael E. DeBakey VAMC ·

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Email: dgraham@bcm.tmc.edu