Reply to Dr. Tucci

I agree that the Mt 21 - 42 device is clever and potentially interesting. It is introduced at the same time that noninvasive diagnostic techniques are becoming increasingly utilized to accomplish similar goals. For example, the combination of a urea breath test or stool antigen test plus serum pepsinogen testing provides a simple approach to the questions regarding whether Helicobacter pylori infection and/or atrophic gastritis is present. Gastric juice analysis, urea breath testing, and the stool antigen test all suffer when the bacterial load is reduced by use of antibiotics, bismuth, or, especially, proton pump inhibitors. The almost universal use of proton pump inhibitors by western dyspeptic patients has had a major negative impact on the diagnostic utility of tests requiring an appreciable bacterial load. This will undoubtedly also reduce the accuracy and utility of the new proposed device. In contrast, histology in these cases will still show atrophy and evidence of chronic gastritis such that a false-positive histology for H. pylori should be recognized. There are many ways to accomplish the same goals. We have a large number of useful techniques to choose from. It is up to the inventors to show that their device is as useful as, or more useful than alternatives in general use.

Competing interests. Dr. Graham receives royalties from Baylor College of Medicine from a patent on the antigen used in the HM-CAP serologic test. He is a member of the board of Meretek, Diagnostic, and receives unconditional support from ChekMed, the manufacturer of the rapid urease test HpFast.

Competing interests: Dr. Graham receives royalties from Baylor College of Medicine from a patent on the antigen used in the HM-CAP serologic test. He is a member of the board of Meretek, Diagnostic, and receives unconditional support from ChekMed, the manufacturer of the rapid urease test HpFast.