Clinical significance of various diagnostic techniques and emerging antimicrobial resistance pattern of Helicobacter Pylori from Gastric Biopsy Samples

Background: There is no single technique that can meet the criteria in identification of Helicobacter pylori. The diagnosis is important asantimicrobial resistance is frequently observed and associated with treatment failure. The present study was conducted to evaluate diagnostic tests for identification of H pylori and to assess their antimicrobial resistance pattern. Materials and Methods: Biopsies of gastric tissue from 200 patients with disorders of the upper gastrointestinal tract were studied for detection of H pylori by various methods like culture, H and E staining and urease test. Antimicrobial susceptibility testing was carried out by Kirby Bauer’s disc diffusion method. Results: Out of 200 patients, H pylori was detected by rapid urease test, H and E staining and culture in 26.5%, 14.5% and 2.5% cases respectively. H and E was taken as the gold standard. Sensitivity of urease test was 76.6% and of culture 13.3%. Specificity of urease was 81.7% in comparison with culture which showed 99.4% specificity. Metronidazole (05) showed high level of resistance followed by amoxicillin (03) and norfloxacillin (03). Tetracycline, erythromycin, levofloxacin and cotrimoxazole showed one resistance each to H pylori. Conclusion: H and E is taken as the gold standard according to CDC. Urease test is a better screening procedure than culture. H pylori resistance to metronidazole in our zone was highest. This is due to general and extensive use of metronidazole for other infectious diseases. Our study suggests need for a systematic approach to determine antibiogram of the strains before considering the drug regimens.