. 2022; 14(1): 35-42 | DOI: 10.14744/iksstd.2021.59389

What Should Be the Optimum Biopsy Time for Helicobactery Pylori in Upper Gastrointestinal System Bleeding Due to Peptic Ulcer?

Cemal Seyhun, Mehmet Abdussamet Bozkurt, Bahadır Kartal
İstanbul Bakirköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

INTRODUCTION: Upper gastrointestinal system (GIS) bleedings are common in the daily practice of general surgeons and are still an emergency situation with high mor-bidity and mortality despite advanced medical and endoscopic treatments. The most common cause of upper gastrointestinal bleeding is peptic ulcer; Helicobacter pylori (HP) has been implicated in the etiology of peptic ulcers. In this study, we aimed to determine the optimum time of biopsy for HP and the optimum time to start HP treatment in patients who applied to the hospital with upper gastrointestinal bleeding and had gastric or duodenal ulcers during their gastroscopic evaluation.
METHODS: Patients who were diagnosed with upper GIS bleeding and had bleeding due to peptic ulcer disease were divided into two groups. In the first group, patients whose bleeding was stopped and who were discharged with medical therapy, and underwent biopsy for HP diagnosis from antrum after 4–6 weeks at control gastroscopy were included. In the second group, patients who underwent a biopsy for HP diagnosis from gastric antrum during the first gastroscopy performed within 6–24 h after admission were included. Endoscopic findings of patients were estimated with Forrest classification and HP densities in biopsy were estimated according to the Sydney classification, and the two groups were compared.
RESULTS: When groups were divided into subgroups according to age, gender, comorbid disease, and history of previous surgery, no significant difference was found between the two groups statistically (p>0.05). When the two groups were considered in terms of rebleeding rates, no statistically significant difference was found between them (p>0.05). No statistically significant difference was found between the groups for HP according to the Sydney classification and Forrest classification in the first endoscopic evaluation (p>0.05).
DISCUSSION AND CONCLUSION: In patients who presented with acute upper GIS bleeding and were hemodynamically stable and had no coagulopathy, we thought that biopsy for HP could be performed safely after bleeding was stopped regardless of the presence of active bleeding in the first endoscopy. Furthermore, biopsy for HP during the first endoscopy may help to reduce the rate of false negativity that may occur due to the proton pump inhibitor treatment that patients will use up to the control endoscopy. We think that there is a need for further studies with large series on this subject.

Keywords: Forrest classification, gastroscopy, helicobacter pylori, Sydney classification, upper gastrointestinal system bleeding

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Peptik Ülsere Bağlı Üst Gastrointestinal Sistem Kanamalarında Helikobakter Pilori için Optimum Biyopsi Zamanı Ne Olmalı?

Cemal Seyhun, Mehmet Abdussamet Bozkurt, Bahadır Kartal
İstanbul Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

GİRİŞ ve AMAÇ: Üst gastrointestinal kanamasının en yaygın nedeni peptik ülserdir; Peptik ülser etiyolojisinde Helicobacter pylori (HP) suçlanmaktadır. Bu çalışmada üst gastrointestinal kanama ile hastaneye başvuran ve gastroskopik değerlendirmede mide veya duodenum ülseri tesbit edilen hastalarda HP için en uygun biyopsi zamanını ve HP tedavisine en uygun başlama zamanını belirlemeyi planladık.
YÖNTEM ve GEREÇLER: Birinci gruba kanaması durdurulan ve medikal tedavi ile taburcu edilen hastalar dahil edildi. İkinci gruba ise ilk gastroskopi sırasında mide antrumun-dan HP tanısı için biyopsi yapılan hastalar dahil edildi. Hastaların endoskopik bulguları Forrest Sınıflaması ve biyopsideki HP dansiteleri Sydney sınıflamasına göre değerlendirildi ve iki grup karşılaştırıldı.
BULGULAR: İki grup karşılaştırıldığında tekrar kanama oranları açısından istatistiksel olarak anlamlı fark saptanmadı (p>0,05). Gruplar Helikobakter Pilori için Sydney sınıflaması ve ilk endoskopik değerlendirmedeki Forrest sınıflamasına göre karşılaştırıldığında her ikisi için de istatistiksel olarak anlamlı fark saptanmadı (p>0,05).
TARTIŞMA ve SONUÇ: Akut üst GİS kanaması ile başvurup hemodinamik olarak stabil ve koagülopatisi olmayan hastalarda ilk endoskopide aktif kanama olup olmadığına bakılmaksızın kanama durdurulduktan sonra HP biyopsisinin güvenle yapılabileceğini düşünmekteyiz. Bu konuda daha geniş serili çalışmalara ihtiyaç oldu-ğunu düşünmekteyiz.

Anahtar Kelimeler: Forrest sınıflaması, gastroskopi, helikobakter pilori, Sydney sınıflaması, üst gastrointestinal sistem kanaması

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