A biopsy urease test in the detection of Helicobacter pylori: comparison of antral and body specimens.

BACKGROUND: This study was to compare the difference of positive rate and reaction time between the antrum and the body specimens in duodenal ulcer (n = 124) and non-duodenal ulcer (n = 181) patients. METHODS: A total of 305 subjects with positive urease test were evaluated. During endoscopy each biopsy specimen from the greater curvature side of the antrum and the body was immediately incubated in a thermostatically controlled 37 degrees C waterbath and examined regularly in the first 6 h, and if there was no response, reexamined after 24 hours. A change from orange to pinkish red was considered positive. RESULTS: There was no difference in the positive rate of urease test between the antrum and the body in patients with duodenal ulcer (95.2% vs. 94.4%); whereas, the positive rate was higher in the body specimens than in the antral specimens in patients without duodenal ulcer (p < 0.05, 97.8% vs. 89%). Antral specimens had more rapid color change of urease test than the body specimens patients with duodenal ulcer; whereas no such difference was found in patients without duodenal ulcer. In the antral specimens of patients without duodenal ulcer who were less than 60 years old, the color change was more rapid than in those older than 60 (median 1.0 hr vs. 1.5 hr, p < 0.05). CONCLUSIONS: For better detection of H. pylori colonization using a urease test, it is critical to choose a suitable biopsy site. In non-duodenal ulcer disease, biopsy of the greater curve of the body has a higher detection rate than that of the antrum. In duodenal ulcer disease, biopsy of the antrum is better than that of the body for its quicker reaction.