Gastric Biopsies: The Gap between Evidence-Based Medicine and Daily Practice in the Management of GastricHelicobacter pyloriInfection

Abstract

BACKGROUND: Many consider histology to be the gold standard forHelicobacter pyloridetection. Because the number and distribution ofH pyloriorganisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum.OBJECTIVE: To assess the influence of clinical practice on the histopathological detection ofH pyloriinfection.METHODS: Electronic patient records were evaluated for the sites of gastric sampling and PPI use at endoscopy. One hundred fifty cases with biopsies taken from both antrum and body were randomly selected for pathological re-review with special stains. The gastric regions sampled,H pyloridistribution and influence of clinical factors on pathological interpretation were assessed.RESULTS: Between 2005 and 2010, 10,268 biopsies were taken to detectH pylori. Only one region was sampled in 60% of patients (antrum 47%, body 13%). Re-review of biopsies taken from both antrum and body indicated that the correct regions were sampled in only 85 (57%) patients. Of these, 54 wereH pyloripositive and 96 wereH pylorinegative.H pyloriwas present in the antrum in only 15% of the patients and body only in 21%. Of 96H pylori-negative patients, two were reinterpreted as positive. Forty-seven per cent of patients were taking PPIs at endoscopy, contributing to both false-negative and false-positive diagnoses.CONCLUSION: Despite national and international guidelines for managingH pyloriinfection, the American Gastroenterological Association guidelines are infrequently adhered to, with PPIs frequently contributing to false diagnosis; sampling one region only increases the likelihood of missing active infection by at least 15%.