Optimizing diagnostic utility for diagnosis and management of Helicobacter pylori infections through combined microbiology and pathology approaches: a 7-year study.

OBJECTIVES: Helicobacter pylori infections result in significant global disease burden related to chronic gastritis, peptic ulcer disease, and gastric cancer. Optimal treatment requires knowledge of local resistance epidemiology. We characterized our patient population infected with H pylori in Washington, DC, United States, and evaluated the diagnostic utility of microbiology and surgical pathology approaches for H pylori diagnosis. METHODS: A retrospective, observational study was performed from April 2015 to March 2022, consisting of patients positive for H pylori. Review of the electronic medical record for patient demographics, clinical presentation, laboratory results, and clinical management was performed. RESULTS: Top clinical presentations in our patients with H pylori infections (n = 31, mean age 51 years) were abdominal pain (55%), gastroesophageal reflux disease (19%), and nausea/vomiting (10%), with most (84%) experiencing recurrent disease. Concordant findings (n = 105 specimens) between microbiology and surgical pathology were noted in 96% of patients. Microbiology testing provided a faster preliminary positive diagnosis by 3 days (P < .00001). For both approaches, antrum biopsy specimens demonstrated a 100% recovery rate (odds ratio [OR], 5.4). Active gastritis was the most common diagnosis (82%), which significantly increased the likelihood of H pylori seen in microbiology smears (OR, 1.7) and viable recovery of the organism (OR, 2.6) for further antimicrobial susceptibility testing. Our antibiogram revealed more than 55% resistance to first-line drugs, with 77% of our isolates being multidrug resistant. CONCLUSIONS: An accurate diagnosis of an H pylori infection is dependent on specimen site and disease severity. Appropriate biopsy collection and ordering of microbiology and surgical pathology tests maximize diagnostic utility. A local antibiogram is essential for guiding empiric therapy.