The effect of omeprazole dosing on the isolation of Helicobacter pylori from gastric aspirates

Abstract

Background: Animal experiments suggest that omeprazole dosing increases shedding of Helicobacter into the gastric lumen, and hence into gastric juice. Aim: To assess the effect of omeprazole dosing on the yield of H. pylori from gastric aspirates of infected volunteers. Methods: Six serial nasogastric aspirates, three before and three during dosing with omeprazole 40 mg b.d., were obtained for culture from 10 H. pylori infected volunteers and one uninfected volunteer. To reduce contamination, samples were diluted 1:10 with Maximum Recovery Diluent (MRD: pH 7.0) or HCl-KCl buffer (pH 2.2) prior to culture on Columbia and Dent's agar. Results: Undiluted gastric juice cultures were rapidly overgrown by upper respiratory tract flora. HCl-KCl dilution resulted in isolation of H. pylori from 77% of infected subject aspirates before, and 67% of aspirates during dosing with omeprazole. The yields were significantly lower with MRD dilution, 47% and 10%, respectively. Omeprazole dosing significantly decreased the yield after MRD dilution, but not after HCl-KCl dilution. Conclusions: Decreasing intragastric acidity, by dosing with omeprazole, decreases the isolation of H. pylori from routinely professed gastric aspirates. In vitro acidification of gastric aspirates, by HCl-KCl dilution, increases the isolation of H. pylori both before and during omeprazole dosing.