Inefficiency of Rapid Urease Test for Confirmation of Helicobacter pylori

Sir,

Foroutan et al.[1] published an article entitled “Accuracy of rapid urease test in diagnosing Helicobacter pylori infection in patients using NSAIDs” in the previous volume of Saudi Journal of Gastroenterology. They have investigated the accuracy of rapid urease test (RUT) in Helicobacter pylori strains during the gastroscopy process. In response to their article, we present our contradictory evidences about the efficacy of RUT test as the confirmation of H. pylori isolates in biopsy specimen. Detection of H. pylori in clinical samples is an important subject for clinicians for further management of this rogue microorganism. Routinely, diagnosis tests of H. pylori are divided into two major groups:[2,3] invasive and noninvasive tests. At this point, we discuss RUT as one of the commonly used noninvasive test, which was applied by Foroutan et al.[1] It was recommended[2,3] that the presence of H. pylori should be confirmed by using at least any two of thee following methods: RUT, histology, UBT (Urea Breath Test), specific PCR assay, and bacterial culture. Nevertheless, they reported H. pylori-positive strains in their study, while no culture or specific PCR assay were performed in their examination.[1] Our data, supported by other reports from Iran,[4] demonstrate that most of the biopsy specimens from the antrum harbor H. pylori, while their RUT was primarily reported as being negative. Foroutan et al.[1] concluded that the use of NSAID does not affect the RUT test result. In our data[4,5] we observed that 30% of RUT-negative patients revealed H. pylori strains after culture and specific gene PCR assay.[2] In other words, we showed that of 340 consecutive patients referred for gastroscopy in our clinic, 95 (27%) were RUT negative.[4,5] This important finding, in contrast to Foroutan et al.[1] study, showed that RUT test does not show a high sensitivity if we perform in a condition with large sample size. In conclusion, we strongly recommended that physicians do not rely on RUT as a test of high sensitivity for test for determination of H. pylori infection.