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Marginean, C.M.;  Cioboata, R.;  Olteanu, M.;  Vasile, C.M.;  Popescu, M.;  Popescu, A.I.S.;  Bondari, S.;  Pirscoveanu, D.;  Marginean, I.C.;  Iacob, G.A.; et al. Diagnostic Methods in H. pylori Infection. Encyclopedia. Available online: https://encyclopedia.pub/entry/39990 (accessed on 01 July 2024).
Marginean CM,  Cioboata R,  Olteanu M,  Vasile CM,  Popescu M,  Popescu AIS, et al. Diagnostic Methods in H. pylori Infection. Encyclopedia. Available at: https://encyclopedia.pub/entry/39990. Accessed July 01, 2024.
Marginean, Cristina Maria, Ramona Cioboata, Mihai Olteanu, Corina Maria Vasile, Mihaela Popescu, Alin Iulian Silviu Popescu, Simona Bondari, Denisa Pirscoveanu, Iulia Cristina Marginean, George Alexandru Iacob, et al. "Diagnostic Methods in H. pylori Infection" Encyclopedia, https://encyclopedia.pub/entry/39990 (accessed July 01, 2024).
Marginean, C.M.,  Cioboata, R.,  Olteanu, M.,  Vasile, C.M.,  Popescu, M.,  Popescu, A.I.S.,  Bondari, S.,  Pirscoveanu, D.,  Marginean, I.C.,  Iacob, G.A.,  Popescu, M.D.,  Stanciu, M., & Mitrut, P. (2023, January 10). Diagnostic Methods in H. pylori Infection. In Encyclopedia. https://encyclopedia.pub/entry/39990
Marginean, Cristina Maria, et al. "Diagnostic Methods in H. pylori Infection." Encyclopedia. Web. 10 January, 2023.
Diagnostic Methods in H. pylori Infection
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This entry is adapted from the peer-reviewed paper 10.3390/antibiotics12010060

Helicobacter pylori (H. pylori) develops potentially life-threatening conditions in adults if not appropriately treated. Helicobacter pylori is a common human pathogen that was first described in the stomach many years ago. 

H. pylori children diagnostics test chronic gastritis

1. Introduction

Among the most widespread childhood infections, Helicobacter pylori (H. pylori) develops potentially life-threatening conditions in adults if not appropriately treated. H. pylori is a common human pathogen that was first described in the stomach many years ago [1]. In 1983, H. pylori was isolated from the gastric antrum by Marshall and Warren and described as a Gram-negative, flagellated, and microaerophilic bacterium [2]. The discovery of H. pylori is of crucial importance in gastroenterology; this bacterium is associated with chronic gastritis, peptic ulcers, gastric cancer, and lymphoid tissue lymphoma associated with the gastric mucosa [3].

2. Noninvasive Diagnostic Tests

2.1. Urea Breath Test

The urea breath test (UBT) was the first method of diagnosis and still represents the most popular noninvasive test for diagnosing H. pylori infection. UBT presents multiple advantages in detecting H. pylori infection, especially in children and teenagers, being a simple, non-invasive, and reliable method, with a sensitivity and specificity of 75% to 100% [4].
A recently published meta-analysis evaluating the diagnostic accuracy of H. pylori infection using UBT in adult patients with specific dyspeptic symptoms revealed a sensitivity of 96% and a common specificity of 93% [5].
UBT is also helpful for epidemiological studies and for evaluating eradication therapy efficiency [6].

2.2. Stool Antigen Test

The stool antigen test (SAT) is a noninvasive method with remarkable sensitivity and specificity, 94% to 97%, used to diagnose H. pylori infection [7].
Also used to confirm eradication after anti-infective therapy, the cumulative sensitivity and specificity for the monoclonal SAT were 93% and 96%, respectively, according to data published in global meta-analyses [7].
The accuracy of the stool antigen diagnosis is influenced by factors such as the use of antibiotics, PPI, or other drugs such as N-acetylcysteine, and the coexistence of complications such as upper digestive hemorrhage. Before testing, sample preservation, temperature, and transport time can influence the diagnostic accuracy of the SAT [8][9].

2.3. Serological Tests

Currently, numerous serological tests are available based on the detection of anti-H. pylori IgG antibodies; the EIA test is the most used. Serological tests are frequently used in the screening of epidemiological studies due to their acceptability for patients, prompt result, and inexpensive cost.
The accuracy of serological tests is not affected by digestive hemorrhaging, gastric atrophy, antibiotics, or PPIs, which cause false negative results in other methods.
The disadvantage of serological tests is the impossibility of evaluating the efficacy of the eradication therapy because the levels of anti-H. pylori antibodies can persist in the blood for a long time, even after the eradication of the infection. Antibody-based tests do not distinguish between active infection and previous exposure to H. pylori, so further confirmation is required before the initiation of eradication therapy [6].
The determination of H. pylori antibodies has a decisive role in studies related to the pathogenesis of the infection and the assessment of virulence factors because specific antigenic proteins can be detected via immunological techniques, thus conferring an additional diagnostic value. Potential biomarkers have been tested to identify subjects infected with H. pylori strains with a high risk of developing complications and assess the prognosis of diseases associated with H. pylori infection.
Thereby, in patients affected by H. pylori, the detection of serum CagA, VacA, and GroEL antibodies was correlated with the development of gastric precancerous lesions and even gastric cancer, making these serum markers potential predictive factors for patients infected with high-risk strains [10][11].

2.4. Polymerase Chain Reaction

A PCR test detects H pylori in stool and is a reliable and fast technique that offers the advantage of identifying specific genotypes, with a possible role in determining the antibiotic resistance of bacteria [12][13].
The detection of infection through PCR in the oral cavity uses H. pylori-specific primer sets based on specific complete genome sequences of 48 H. pylori strains, increasing the diagnostic accuracy [14].

3. Invasive Tests

3.1. Endoscopy

Conventional endoscopic examination is routinely performed to evaluate lesions associated with H. pylori (chronic atrophic gastritis, peptic ulcers, MALT lymphomas, and gastric cancer). Endoscopy is also used for taking biopsy samples from the gastric mucosa for further determinations, such as rapid urease tests, histopathological examinations, cultures, and molecular methods. The biopsy is preferably performed from the gastric antrum.
Chromoendoscopy with phenol red is a method used for detecting H. pylori infection due to the specific urease activity of the bacterium, but its sensitivity (73–81%) and specificity (76–81%) are low [15][16].
Confocal laser endomicroscopy (CLE) represents an endoscopic method that allows the histological examination of the gastric mucosa. Characteristic for the positive diagnosis of H. pylori infection is the presence, at laser confocal endomicroscopy, of white spots, neutrophils, and sometimes micro-abscesses. The accuracy, sensitivity, and specificity of this method have been evaluated in various studies at 92.8%, 89.2%, and 95.7%, respectively [17].

3.2. Histological Examination

The histological examination is the gold standard for diagnosing H. pylori infection. The examiner’s experience influences the accuracy of the diagnosis, size, site, number of biopsies, and staining procedures, as well as the use of inhibitors of the proton pump (PPI) and antibiotics.

3.3. The Rapid Test with Urease

The rapid urease test (RUT) is considered the most useful invasive test in the diagnosis of H. pylori infection because it is quickly available, not expensive, easy to perform, and, in particular, has a sensitivity of over 85–95% and a specificity between 95% and 100%, with increased accuracy with the number of gastric biopsies [18].

3.4. Microbiological Culture

The cultivation of H. pylori from the gastric biopsy sample is a diagnostic method with a specificity of approximately 100% but less sensitivity, with variability between 85% and 95%. Culturing allows the isolation of H. pylori for subsequent phenotypic and genotypic characterization, with a role in the efficiency of the therapeutic scheme. The cultivation of H. pylori provides the ability to manage and assess antibiotic resistance in extensive observational studies [6].

3.5. Polymerase Chain Reaction

PCR is widely used to detect H. pylori infection from gastric biopsy samples, saliva, and stool. Compared to conventional tests, PCR offers a sensitivity and specificity above 95%. PCR provides information on H. pylori’s virulence factors by detecting specific mutations that determine antibiotic resistance, such as resistance to macrolides and fluoroquinolones [19][20].

References

  1. Moodley, Y.; Linz, B.; Bond, R.P.; Nieuwoudt, M.; Soodyall, H.; Schlebusch, C.M.; Bernhöft, S.; Hale, J.; Suerbaum, S.; Mugisha, L.; et al. Age of the Association between Helicobacter pylori and Man. PLoS Pathog. 2012, 8, e1002693.
  2. Marshall, B.J.; Warren, J.R. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984, 1, 1311–1315.
  3. Hu, Y.; Zhu, Y.; Lu, N.-H. Novel and Effective Therapeutic Regimens for Helicobacter pylori in an Era of Increasing Antibiotic Resistance. Front. Cell. Infect. Microbiol. 2017, 7, 168.
  4. Guarner, J.; Kalach, N.; Elitsur, Y.; Koletzko, S. Helicobacter pylori diagnostic tests in children: Review of the literature from 1999 to 2009. Eur. J. Pediatr. 2010, 169, 15–25.
  5. Ferwana, M.; Abdulmajeed, I.; Alhajiahmed, A.; Madani, W.; Firwana, B.; Hasan, R.; Altayar, O.; Limburg, P.J.; Murad, M.H.; Knawy, B. Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis. World J. Gastroenterol. 2015, 21, 1305–1314.
  6. Malfertheiner, P.; Megraud, F.; O’morain, C.A.; Gisbert, J.P.; Kuipers, E.J.; Axon, A.T.; Bazzoli, F.; Gasbarrini, A.; Atherton, J.; Graham, D.Y.; et al. Management of Helicobacter pylori infection—The Maastricht IV/Florence Consensus Report. Gut 2012, 61, 646–664.
  7. Gisbert, J.P.; De La Morena, F.; Abraira, V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: A systematic review and meta-analysis. Am. J. Gastroenterol. 2006, 101, 1921–1930.
  8. Demirtürk, L.; Yazgan, Y.; Tarçın, O.; Özel, M.; Diler, M.; Öncül, O.; Yıldırım, Ş. Does N-acetyl cystein affect the sensitivity and specificity of Helicobacter pylori stool antigen test? Helicobacter 2003, 8, 120–123.
  9. Shimoyama, T. Stool antigen tests for the management of Helicobacter pylori infection. World J. Gastroenterol. 2013, 19, 8188–8191.
  10. Pan, K.F.; Formichella, L.; Zhang, L.; Zhang, Y.; Ma, J.L.; Li, Z.X.; Liu, C.; Wang, Y.M.; Goettner, G.; Ulm, K.; et al. Helicobacter pylori antibody responses and evolution of precancerous gastric lesions in a Chinese population. Int. J. Cancer 2014, 134, 2118–2125.
  11. Karami, N.; Talebkhan, Y.; Saberi, S.; Esmaeili, M.; Oghalaie, A.; Abdirad, A.; Mostafavi, E.; Hosseini, M.E.; Mohagheghi, M.A.; Mohammadi, M. Seroreactivity to Helicobacter pylori Antigens as a Risk Indicator of Gastric Cancer. Asian Pac. J. Cancer Prev. 2013, 14, 1813–1817.
  12. Sicinschi, L.A.; Correa, P.; Bravo, L.E.; Peek, R.M.; Wilson, K.T.; Loh, J.T.; Yepez, M.C.; Gold, B.D.; Thompson, D.T.; Cover, T.L.; et al. Non-invasive Genotyping of Helicobacter pylori cagA, vacA, and hopQ from Asymptomatic Children. Helicobacter 2012, 17, 96–106.
  13. Xiong, L.J.; Tong, Y.; Wang, Z.; Mao, M. Detection of clarithromycin-resistant Helicobacter pylori by stool PCR in children: A comprehensive review of literature. Helicobacter 2013, 18, 89–101.
  14. Ogaya, Y.; Nomura, R.; Watanabe, Y.; Nakano, K. Detection of Helicobacter pylori DNA in inflamed dental pulp specimens from Japanese children and adolescents. J. Med. Microbiol. 2015, 64, 117–123.
  15. Cho, Y.-S.; Chae, H.-S.; Na Jang, S.; Kim, J.-S.; Son, H.S.; Kim, H.-K.; Kim, B.-W.; Han, S.-W.; Choi, K.-Y.; Lee, H.K.; et al. Comparison of the 13C-urea breath test and the endoscopic phenol red mucosal pH test in the quantification of Helicobacter pylori infection loading. Korean J. Intern. Med. 2008, 23, 134–139.
  16. Hernández-Garcés, H.R.; Castellanos-González, V.V.; González-Fabián, L.; Infante-Velázquez, M.; Peña, K.; Andrain-Sierra, Y. Chromoendoscopy with red phenol in the diagnosis of Helicobacter pylori infection. Rev. Esp. Enferm. Dig. 2012, 104, 4–9.
  17. Ji, R.; Li, Y.Q.; Gu, X.M.; Yu, T.; Zuo, X.L.; Zhou, C.J. Confocal laser endomicroscopy for diagnosis of Helicobacter pylori infection: A prospective study. J. Gastroenterol. Hepatol. 2010, 25, 700–705.
  18. Vaira, D.; Vakil, N.; Gatta, L.; Ricci, C.; Perna, F.; Saracino, I.; Fiorini, G.; Holton, J. Accuracy of a new ultrafast rapid urease test to diagnose Helicobacter pylori infection in 1000 consecutive dyspeptic patients. Aliment. Pharm. 2010, 31, 331–338.
  19. Momtaz, H.; Souod, N.; Dabiri, H.; Sarshar, M. Study of Helicobacter pylori genotype status in saliva, dental plaques, stool and gastric biopsy samples. World J. Gastroenterol. 2012, 18, 2105–2111.
  20. Lehours, P.; Mégraud, F. Helicobacter pylori molecular diagnosis. Expert Rev. Mol. Diagn. 2011, 11, 351–355.
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Subjects: Gastroenterology & Hepatology
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Cristina Maria Marginean
,
Ramona Cioboata
,
Mihai Olteanu
,
Corina Maria Vasile
,
Mihaela Popescu
,
Alin Iulian Silviu Popescu
,
Simona Bondari
,
Denisa Pirscoveanu
,
Iulia Cristina Marginean
,
George Alexandru Iacob
,
Mihai Daniel Popescu
,
Mihaela Stanciu
,
Paul Mitrut
View Times: 418
Entry Collection: Gastrointestinal Disease
Revisions: 2 times (View History)
Update Date: 11 Jan 2023
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