Introduction

Since the discovery of Helicobacter pylori (Hp) by Marshall and Warren in 1983 (1), over- whelming evidence has accumulated to confirm that Hp infection plays significant role in the development of chronic active gastritis, peptic ulcer, and gastric adenocarcinoma (2-6). Hp infection is very common throughout the world, occurring in 40-50% of the population in developed countries and 80-90% of the population in developing regions (7), and about 54.4% of the people in Taiwan (8).

A large number of methods, most of which require gastric biopsies, have been used to diagnose Hp infection, but there is no single gold standard test for the diagnosis of Hp infection (9-11). Every method for detection of Hp has its own inherent advantages and disadvantages. Although biopsy based tests may suffer from sampling error (12) due to the

patchy nature of the infection, rapid urease test (RUT), with its high sensitivity and specificity, is considered to be a quick and reliable test for the initial diagnosis of Hp infection. Also, RUT is simple and inexpensive (13-16). When a biopsy is incubated in a medium containing urea and a pH-sensitive color marker, urease hydrolyses urea to carbon dioxide

Hepato-Gastroenterology 2002; 49:1191-1194 and ammonia, causing a rise in pH value and a change in the color of the medium.

In the past, the reaction time of most RUTs required 30 minutes on average, may have needed more than 4 hours in some cases (17,18). Patients must know the RUT results before their next visit to the OPD. If the reaction time can be reduced to less than 10 minutes, it allows a diagnosis to be made before the

patient leaves the endoscopy suite. This may save on medical expenses due to repeated visits to the clinic and reduce paper work. It may also increase the success rate of eradicating Hp, because compliance is considered a major factor in the successful treatment of Hp, compliance may improve significantly if we make an early diagnosis of Hp infection and initiate therapy (19).

The present prospective study was undertaken to evaluate the validity of RUTs containing different media. This evaluation included accuracy, reaction time and cost-effectiveness. We also wanted to evaluate the positive reaction of different RUTs in relation to various colonies of Hp, and the accuracy of different RUTs in patients who had received prior Hp eradication therapy.