Because such methods are complicated and time-intensive, it is impractical to use such tests for primary diagnostic purposes in the clinic. Statement 14. It is preferable to obtain biopsy samples from both the gastric antrum and body for invasive diagnostic tests of H. pylori infection. If the samples are obtained from only one area, they should be obtained from the area where mucosal atrophy and intestinal metaplasia are not present or are minimal. Level of evidence B, Grade of recommendation 1 Experts’ GSK2126458 opinions: completely agree (40.0%), mostly agree (56.7%), partially agree (0%), mostly disagree (3.3%), completely disagree (0%), not sure
(0%) Invasive diagnostic tests for H. pylori infection can produce false-negatives
based on the location of the biopsy and the number of biopsy samples because H. pylori may not be evenly distributed in the gastric mucosa.[92, 93] Mucosal atrophy and intestinal metaplasia are particularly unfavorable environments for the survival of H. pylori.[94, 95] Thus, it is preferable to obtain more than two samples from both the antrum and body for accurate diagnosis.[92, 93] If dual sampling is difficult as a result of increased procedure time, cost, and risk of bleeding at the biopsy sites, tissue samples should be obtained from areas where the mucosal atrophy and intestinal metaplasia are not present or are minimal. It has been reported that biopsy specimens from the gastric http://www.selleckchem.com/products/obeticholic-acid.html body had equivalent or higher diagnostic accuracy compared with those from the gastric antrum where mucosal atrophy or intestinal metaplasia were commonly present.[94-96] Statement 15. Urea breath or stool antigen tests are the recommended non-invasive methods, and histology or rapid urease tests from the gastric antrum and body are the recommended invasive tests to confirm H. pylori eradication. Tests should be performed at least 4 weeks after completion of eradication or 2 weeks after PPI use. Level of evidence B, Grade of recommendation 1 Experts’ opinions: completely agree (22.6%), mostly Orotidine 5′-phosphate decarboxylase agree (48.4%), partially
agree (9.7%), mostly disagree (3.2%), completely disagree (9.7%), not sure (6.5%) It is recommended that any test confirming H. pylori eradication should be conducted at least 4 weeks after the completion of eradication or 2 weeks after treatment with PPI because of the possibility of a false-negative result.[15, 26, 39, 97] The urea breath test is convenient and non-invasive, with reproducibility, sensitivity, and specificity all greater than 95%, and thus is recommended as the primary confirmatory test for H. pylori eradication.[81, 98] The stool antigen test is also useful for confirming H. pylori eradication with a sensitivity of 89% and a specificity of 92% in children. However, it is inconvenient and has low diagnostic accuracy when polyclonal antibodies are used.[99, 100] Histology or rapid urease tests can be used to confirm H.