Real-Time PCR Helicobacter pylori Test in Comparison With Culture and Histology for Helicobacter pylori Detection and Identification of Resistance to Clarithromycin: A Single-Center Real-Life Study.

Background: In our center, RT-PCR was integrated as a routine method to diagnose Helicobacter pylori due to its higher availability after COVID-19 pandemics. The objective of this study was to assess the feasibility and performance of systematically performed RT-PCR for H. pylori detection and clarithromycin (CLA) resistance in a real-life clinical practice.

Materials And Methods: One hundred consecutive patients underwent an upper digestive endoscopy during which at least four biopsies (two from the antrum and two from the corpus) were obtained for RT-PCR and culture with antibiogram and four additional biopsies for histology. The results of H. pylori detection were compared among RT-PCR, histology, and bacterial culture, and the results of CLA susceptibility were compared between culture-based antibiogram and RT-PCR.

Results: Out of 100 patients, 64 were positive for H. pylori by RT-PCR, 66 by histology, and 53 by culture, with no statistically significant difference among the three methods (p > 0.05). CLA resistance was found in 8 out of 45 patients (17.7%) by culture and in 12 out of 64 patients (18.7%) by PCR. In 8 H. pylori-positive patients by culture, the antibiogram could not be realized due to lack of viability of the strains. In one patient, after a double checking, discrepant results were observed, requiring a complementary molecular analysis by the French National Reference Center for Helicobacters, which confirmed the existence of a double population of H. pylori strains within biopsies, with and without CLA resistance.

Conclusions: Our study demonstrates that in real-life clinical practice, RT-PCR is feasible and comparable in the ability to detect H. pylori and its resistance to CLA to bacterial culture with antibiogram and histology. Given its rapidity and limited dependence on the operator's interpretation, it appears preferable to the other methods.