From the Guidelines
Gastrointestinal (GI) bleeding does not preclude the performance of Helicobacter pylori (H. pylori) biopsies, and they should be performed as soon as possible after the bleeding has been controlled.
Key Considerations
- H. pylori eradication treatment should be started at reintroduction of oral feeding in cases of bleeding ulcer, as it can effectively prevent bleeding recurrence in infected patients 1.
- Testing for H. pylori should be performed in patients with upper GI bleeding, and eradication therapy should be initiated if infection is present, as post-treatment H. pylori infection status is an independent predictor of rebleeding 1.
- Optimal diagnostic approach for H. pylori infection in the context of acute bleeding is unclear, but may include acute testing followed by a confirmatory test outside the acute context of bleeding 1.
- Oral therapy can be initiated either immediately or during follow-up in patients found to have H. pylori infection, as there is no rationale for urgent intravenous eradication therapy 1.
Clinical Implications
- Early initiation of H. pylori eradication treatment can help prevent recurrent bleeding in infected patients.
- Testing for H. pylori should be part of the routine management of patients with upper GI bleeding.
- Clinical judgment should be used to determine the optimal timing and approach for H. pylori testing and treatment in individual patients.
From the Research
Effect of GI Bleeding on H. pylori Biopsies
- GI bleeding may affect the accuracy of H. pylori diagnostic testing, with some studies suggesting a decrease in sensitivity 2, 3.
- The sensitivity of rapid urease testing (RUT) may be lower in patients with acute GI bleeding, with a sensitivity of 48.5-79% 2, 3.
- Histology may be a more reliable method for diagnosing H. pylori infection in patients with GI bleeding, with a sensitivity of 74-91% 4, 5.
Timing of H. pylori Biopsies
- H. pylori biopsies can be performed during acute GI bleeding, but the results may not be accurate due to the potential for false-negative results 2, 6.
- Repeat biopsies may be necessary 1-2 months after the initial bleeding episode to confirm the presence of H. pylori infection 6.
- The use of proton pump inhibitors and antibiotics prior to biopsy may also affect the accuracy of H. pylori diagnostic testing 6, 3.
Diagnostic Methods for H. pylori Infection
- RUT is a commonly used method for diagnosing H. pylori infection, but it may have a lower sensitivity in patients with GI bleeding 2, 5, 3.
- Histology is a more reliable method for diagnosing H. pylori infection, especially in patients with GI bleeding 4, 5.
- The combination of RUT and histology may provide a more accurate diagnosis of H. pylori infection in patients with GI bleeding 4, 5.