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Background  Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of  H. pylori  infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based  H. pylori  tests in a late post-treatment setting.    Methods  Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and  13  C-UBT  tests were performed.    Results  Seventeen patients were defined  H. pylori  positive by  13  C-UBT  test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4  H. pylori  positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were  H. pylori  positive. Mucosal atrophy and intestinal metaplasia were revealed both in the  H. pylori  positive and  H. pylori  negative cases. Bacteriological examination revealed three clarithromycin resistant  H. pylori  strains. Cytology failed to prove validity for diagnosing  H. pylori  in a post-treatment setting.    Conclusions  In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of  H. pylori  colonisation, PCR and bacteriology as they have shown good concordance with  13  C-UBT . Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic  H. pylori  positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of  H. pylori , aimed at successful eradication of infection in persistent peptic ulcer cases.

The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting