Basic Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Jan 22, 2022; 13(1): 34-40
Published online Jan 22, 2022. doi: 10.4291/wjgp.v13.i1.34
Combined antrum and corpus biopsy protocol improves Helicobacter pylori culture success
Denise E Brennan, Colm O'Morain, Deirdre McNamara, Sinead M Smith
Denise E Brennan, Colm O'Morain, Deirdre McNamara, Sinead M Smith, Department of Clinical Medicine, Trinity College Dublin, Trinity Centre, Tallaght University Hospital, Dublin D24, Ireland
Author contributions: McNamara D conceived the study; Brennan DE and Smith SM performed experiments, acquired and analysed data; O’Morain C and McNamara D recruited patients and collected samples; Smith SM prepared the manuscript; all authors critically reviewed the manuscript and approved the final version; Smith SM and McNamara D contributed equally.
Supported by Health Research Board, No. HRA-POR-2014-526, and No. APA-2019-030.
Institutional review board statement: The study was reviewed and approved by the Joint Research Ethics Committee of St. James’s Hospital and Tallaght University Hospital.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sinead M Smith, BSc, PhD, Assistant Professor, Department of Clinical Medicine, Trinity College Dublin, Trinity Centre, Tallaght University Hospital, Tallaght, Dublin D24, Ireland.
Received: July 23, 2021
Peer-review started: July 23, 2021
First decision: October 3, 2021
Revised: October 16, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: January 22, 2022

Helicobacter pylori (H. pylori) causes chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. Eradication rates have fallen, mainly due to antimicrobial resistance. Consensus guidelines recommend that first-line treatment is based on the local prevalence of antimicrobial resistance and that rescue therapies are guided by antimicrobial susceptibility testing (AST). However, H. pylori culture is challenging and culture-based AST is not routinely performed in the majority of hospitals. Optimisation of H. pylori culture from clinical specimens will enable more widespread AST to determine the most appropriate antimicrobials for H. pylori eradication.


To determine whether dual antrum and corpus biopsy sampling is superior to single antrum biopsy sampling for H. pylori culture.


The study received ethical approval from the joint research ethics committee of Tallaght University Hospital and St. James’s Hospital. Patients referred for upper gastrointestinal endoscopy were invited to participate. Biopsies were collected in tubes containing Dent’s transport medium and patient demographics were recorded. Biopsies were used to inoculate Colombia blood agar plates. Plates were incubated under microaerobic conditions and evaluated for the presence of H. pylori. Statistical analyses were performed using Graphpad PRISM. Continuous variables were compared using the two-tailed independent t-test. Categorical variables were compared using the two-tailed Fisher exact test. In all cases, a P value less than 0.05 was considered significant.


In all, samples from 219 H. pylori-infected patients were analysed in the study. The mean age of recruited patients was 48 ± 14.9 years and 50.7% (n = 111) were male. The most common endoscopic finding was gastritis (58.9%; n = 129). Gastric ulcer was diagnosed in 4.6% (n = 10) of patients, while duodenal ulcer was diagnosed in 2.7% (n = 6). Single antrum biopsies were collected from 73 patients, whereas combined antrum and corpus biopsies were collected from 146 patients. There was no significant difference in age, sex or endoscopic findings between the two groups. H. pylori was successfully cultured in a significantly higher number of cases when combined antrum and corpus biopsies were used compared to a single antrum biopsy [64.4% (n = 94/146) vs 49.3% (36/73); P = 0.04)].


Combined corpus and antrum biopsy sampling improves H. pylori culture success compared to single antrum biopsy sampling.

Keywords: Helicobacter pylori, Culture, Antimicrobial susceptibility testing, Antimicrobial, Antrum, Corpus

Core Tip: Helicobacter pylori (H. pylori) antimicrobial susceptibility testing is critical to accurately detect antimicrobial resistance, thereby influencing appropriate treatment choices, promoting antimicrobial stewardship and increasing H. pylori eradication rates. However, H. pylori culture represents a challenge and is limited to a small number of specialized centres and reference laboratories. Increasing biopsy sample number has been suggested to improve culture success, but data directly comparing dual biopsy vs single biopsy sample collection for H. pylori culture are lacking. Here we show that combined corpus and antrum biopsy sampling improves H. pylori culture success compared to single antrum biopsy sampling.