Brief Reports
Copyright ©2005 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 21, 2005; 11(3): 382-385
Published online Jan 21, 2005. doi: 10.3748/wjg.v11.i3.382
Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers
Hwai-Jeng Lin, Wen-Ching Lo, Chin-Lin Perng, Guan-Ying Tseng, Anna Fen-Yau Li, Yueh-Hsing Ou
Hwai-Jeng Lin, Division of Gastroenterology, Department of Medicine, VGH-Taipei, Taiwan
Wen-Ching Lo, Chung-Hsiao Municipal Hospital, Taipei, Taiwan
Chin-Lin Perng, I-Lan Hospital, Department of health, Taiwan
Guan-Ying Tseng, Ton-Yen General Hospital, Hsin-Chu, Taiwan
Anna Fen-Yau Li, Department of Pathology, VGH-Taipei, Taiwan
Yueh-Hsing Ou, Institute of Biotechnology in Medicine, School of Medical Technology and Engineering, and School of Medicine, National Yang-Ming University, Taiwan
Author contributions: All authors contributed equally to the work.
Supported by grants VGH 92-230 and NSC92-2314-B075-049
Correspondence to: Professor Hwai-Jeng Lin, Division of Gastroenterology, Department of Medicine, VGH-Taipei, Shih-Pai Rd, Sec 2, Taipei, 11217, Taiwan. hjlin@vghtpe.gov.tw
Telephone: +886-2-28712121-2015 Fax: +886-2-28739318
Received: April 28, 2004
Revised: May 1, 2004
Accepted: June 18, 2004
Published online: January 21, 2005
Abstract

AIM: Helicobacter pylori (H pylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma. Conventional invasive tests are less sensitive than non-invasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers.

METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test, histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of H pylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2), iceA1, iceA2 and cag A.

RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%) and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity, positive predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79% and 81%) than in patients with non-bleeding peptic ulcers (99%, 99% and 98%) (P<0.001, P<0.01 and P<0.001 respectively). The sensitivity, negative predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori were significantly lower in patients with bleeding peptic ulcers (84%, 83% and 81%) than in patients with chronic gastritis (100%, 100% and 100%) (P = 0.02, P = 0.02 and P = 0.001).

CONCLUSION: Mucosal polymerase chain reaction for detecting H pylori infection is not reliable in patients with bleeding peptic ulcers.

Keywords: Helicobacter pylori infection; Bleeding peptic ulcers; Mucosal polymerase chain reaction