Combined Algorithm in the Diagnosis of Helicobacter Pylori in Patients with Upper Gastrointestinal Bleeding
Keywords:
Helicobacter pylori; gastrointestinal bleeding; diagnostic tests; peptic ulcerAbstract
Introduction: Helicobacter pylori infection is a risk factor for peptic upper gastrointestinal bleeding.
Objective: To compare the diagnostic performance of three tests for detecting Helicobacter pylori infection in patients with peptic upper gastrointestinal bleeding.
Methods: A descriptive and exploratory observational study was conducted with 20 patients affected by peptic upper gastrointestinal bleeding (Forrest IIc/III), admitted between January 2023 and October 2024, at the Dr. Carlos J. Finlay Central Military Hospital. Helicobacter pylori was diagnosed using the rapid urease test, IgG antibody serology, and histology. A positive case was defined as at least two diagnostic tests or one positive histological finding.
Results: The frequency of Helicobacter pylori infection determined by a combined algorithm was 95.0% (19/20). The rapid urease test showed significantly lower sensitivity (70.0%) compared to histology and serology (90.0% each). Duodenal ulcer was the most frequent endoscopic lesion (36.8%), and intense chronic active gastritis predominated (36.8%).
Conclusions: The frequency of Helicobacter pylori in patients with non-variceal upper gastrointestinal bleeding is very high. The rapid urease test used alone underestimates the diagnosis in this clinical context. The use of a diagnostic algorithm combining laboratory tests based on gastric biopsy studies and serology can detect a greater number of positive cases.
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