Treatment and Resistance Of Helicobacter Pylori in Waitemata, Auckland

A single centre prospective study of consecutive patients attending for gastroscopy who have biopsies to assess for Helicobacter Pylori (H. pylori) (clinician discretion) . Questionnaire provided: 15 questions assessing demographic data and socioeconomic data points which takes 5-10 minutes to fill. This is completed before the biopsy below. Gastroscopy performed. 2x gastric biopsies obtained from the antrum and body for immediate urease testing. The urease test, also known as CLO testing (campylobacter-like organism test) is a rapid, sensitive and cost-effective test. This is held at ambient air temperature and read within 60 minutes for positivity. 4 further biopsies (2 from antrum, 2 from body) obtained for culture and placed into 1 ml of brain-heart infusion (BHI) broth, labelled with patient information and refrigerated. This is sent to microbiology department at Middlemore Hospital within 24 hours if the Urease test is positive, otherwise it is discarded. Positive CLO samples are sent to the Malaghan Institute of Medical Research, Wellington, for polymerase chain reaction (PCR) testing. Phenotypic resistance to each antibiotic will be determined by detecting specific mutations which typically alter the uptake or efflux of the antibiotic. DNA extraction will be performed using a commercially available DNA extraction kits. The DNA will be stored at -80°C until testing is performed. The presence of H. pylori DNA will be confirmed using PCR. Molecular testing for mutations conferring antimicrobial resistance will be tested using droplet digital PCR. Duration of observation for each participant will be from time of enrolment for 12 months