Brush citology: a reliable method in detecting helicobacter pylori infection

Background. In the last few years heficobacter pylori (HP) has been increasingly recognized as main etiologic factor of gastris and peptic ulcer, therefore modifying the diagnostic and therapeutic approach to these diseases. New less invasive diagnostic techniques have been developing to make a correct diagnosis and evaluate the effectiveness of medical treatment. Objective. The goal of this study was to assess the usefulness of brush cytology and compare its diagnostic accuracy with urease test in detecting HP in patients suffering from gastric or peptic ulcer. Patients. The study group consisted of 213 consecutive patients who underwent elective gastroduodenoscopy. Twenty-six (10%) patients had duodenal ulcer, 27 (34%) chronic gastritis and the remaining 115 (56%) had duodenal ulcer but were on treatment with omeprazole (75 patients) or ranitidine (40 patients). Methods. At endoscopy accurate brushing was obtained prior to biopsy. Cytology material was smeared and methilene blue-stained sections were then prepared for light microscopy. Biopsies obtained were treated for the ureasc test. Results of both methods were available within one hour. Results. Brush cytology was more sensible than urease test in detecting HP in patients with either chronic gastritis (55% vs 36%) or duodenal ulcer after omeprazole treatment (75% vs 51%). In the remaining patients with duodenal ulcer with no concomitant medication or ranitidine therapy. Brushing has accuracy equal to that of urease test in identifying HP (i.e.94% vs 84%). Conclusions. Brush citology is a simple, reliable, relatively non-invasive and inexpensive method in detecting HP in persons with gastritis or peptic ulcer. This technique is more sensible than the urease test for assessing HP colonization when gastric density is low (i.e. after omeprazole therapy or in chronic gastritis).