Diagnosing Helicobacter Pylori Infection in Patients with Dyspepsia in Gastrointestinal Endoscopy Centre

Background: Diagnosis of H. pylori infection is important in patient with dyspepsia. There are several methods in the diagnosis of H. pylori infection. Histopathology is still the gold standard, but it requires more time and higher cost. Rapid diagnosis from biopsy sample using urease test has been developed to provide rapid on-site diagnosis. This study aims to obtain accuracy of rapid urease test in diagnosis of H. pylori. Method: Patients with dyspepsia in Cipto Mangunkusumo National General Hospital who underwent esofagogastroduodenoscopy was included in this study. Biopsy sample was taken for rapid urease test using Helicotec and histopathology examination. Results: Conclusion: Rapid urease examination using Helicotec for H.pylori infection has a good accuracy, faster and cheaper. Interpretation of rapid urease test also need to consider clinical condition of patients who are tested.


INTRODUCTION
Helicobacter pylori is one of the most important infectious agents in the world. These bacteria infect 50% of the world population. Gastritis due to H. pylori has been associated with the incidence of peptic ulcer, B cell primary lymphoma in the stomach, and gastric carcinoma. In dyspepsia, eradication of H. pylori helps 1 Prevalence of H. pylori is quite high in less developed Asian countries, such as India, Bangladesh, Pakistan, and Thailand. A study in Jakarta found that the prevalence of H. pylori infection decreases from 12.8% in 1998 to 2.9% in 2005. Several risk factors which have been associated with H. pylori infection include age, social economy class, geographical area (more H. pylori infected individuals in rural areas compared to urban areas), and several dietary factors. 2,3 Among those factors, social economy class is an independent risk factor.
To date, the gold standard test to diagnose H. pylori infection is histopathology and culture amount of preparation time, this method is not ideal for implementation in daily practice. Upon further development, other supporting examinations have been developed. One of those tests is through detection of urease enzyme from tissue biopsy. This method is faster in diagnosing H. pylori infection. Several urease tests which are commercially available in Indonesia include Helicotec and Pronto Dry. discomfort sensation, centred around the upper region of the abdomen and if accompanied with predominant or often (more than once a week); heartburn or acid regurgitation need to be considered as gastroesophageal (GERD) until proven otherwise. 4 In dyspeptic patients, it was stated by McColl et al that patients with dyspepsia who are positively infected by H. pylori has the possibility of duodenal ulcer as much as 40% and gastric ulcer 13%, while dyspepsia patients with negative H. pylori only has the possibility of duodenal ulcer of 2% and gastric ulcer of 3%. 5 This study aimed to evaluate urease test in diagnosing H. pylori infection in dyspepsia patients. It which can become the basis of routine use of urease examination in diagnosing H. pylori infection.

METHOD
This study used diagnostic study design. This study was performed in adult dyspepsia patients who underwent endoscopy examination in Gastrointestinal Endoscopy Centre Cipto Mangunkusumo General The inclusion criteria were dyspepsia patients, aged more than 18 years, and indicated to undergo upper gastrointestinal tract endoscopy. Exclusion criteria include patients who were pregnant or breastfeeding, refused endoscopy examination, had contraindication to undergo endoscopy, had endoscopic results of gastric malignancy, or consumed antibiotics, nonsteroidal antiin the previous 2 weeks.
Patients who fulfilled the inclusion criteria underwent endoscopic examination and biopsy samples were obtained from two points in the antrum and one point in the corpus. One biopsy sample was intended for rapid urease test using Helicotec which was performed according to the standard procedure and was interpreted 2 hours later. Biopsy for histopathological examination was preserved in formalin solution and sent to Histopathology Department for analysis and identification of H. pylori bacteria. Interpretation of histopathological examination of gastric biopsy sample was performed using Updated Sydney System Statistical analysis was performed to obtain negative predictive value (NPV), and likelihood ratio

RESULTS
There were 97 patients participated in this study, comprising of 40 (41,2%) male and 57 (58,8%) female characteristics were presented in table 1. Endoscopic results were shown in Table 2. test might be increased using bigger biopsy forceps (jumbo forceps). 7 Interpretation of rapid urease test also need to consider pre-test probability value of each case. 8 For example, in a case with duodenal ulcer, negative histopathological examination. Additionally, rapid urease test should not be used as a single test in evaluating results of H. pylori eradication because its sensitivity is not 100%. 9,10 Rapid urease test using Helicotec has a good may give result in relatively short time with lower cost.

CONCLUSION
Rapid urease examination using Helicotec is one of H. pylori diagnostic tools that is good enough to diagnose faster and cheaper. Interpretation of rapid urease test also need to consider clinical condition of patients who are tested.