Research
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Helicobacter pylori Screening
(Download 
Helicobacter pylori Screening.pdf)
Background
It is estimated that 10% of the population are afflicted by peptic ulcer disease. The Helicobacter pylori (HP) bacterium is thought to be the cause of most peptic ulcers. Helicobacter seroprevalence rates rise with age and lower socio-economic status, with rates of >50% in Australians aged over 50 years.
Rationale of Testing
Patients with peptic ulcers in whom HP infection is documented will in most cases have their symptoms and ulceration cured by combination antimicrobial therapy that eradicates the organism. The various approaches that have been used to diagnose HP infection are listed in the following table, indicating the best-published figures for sensitivity and specificity for each test.
Methods for Diagnosis HP Infection |
Method |
Sensitivity (%) |
Specificity (%) |
Comments |
Invasive Methods |
|
|
|
Histology of gastric biopsy |
95-99 |
95-99 |
Sampling site errors do occur; detects coccoidal forms of HP only |
Culture gastric biopsy |
70-90 |
100 |
Sampling site errors do occur; provides antibiotic sensitivity |
Rapid urease test |
90-95 |
95-98 |
Rapid result; sampling errors do occur |
Gastric biopsy PCR |
95 |
100 |
Very sensitive; false-positives can occur |
Non-Invasive Methods |
|
|
|
Serology |
95 |
95 |
Unable to confirm eradication |
C13-urea breath test |
95-98 |
95-98 |
Expensive; requires mass spectroscopy; confirms eradication |
C14-urea breath test |
95-98 |
95-98 |
Radioactive contra-indicated in pregnancy and children; requires gamma counter; confirms eradication |
Stool culture |
30-50 |
100 |
Technically difficult; can provide antibiotic sensitivity |
Stool EIA |
89-94 |
91-95 |
Technical sampling errors; less sensitive |
Based upon an extensive literature review and an assessment of available methodologies by HAPS, we offer the following recommendations for diagnosing and monitoring HP infection.
Diagnosing HP Infection
Serological testing, measuring IgG antibodies to HP, represents the most sensitive assessment for HP infection. It is not prone to the sampling error problems seen with more direct approaches such as histology and Clotest assessment, and avoids the inconvenience of medication cessation associated with breath testing.
We do not recommend faecal HP antigen testing for HP diagnosis as this method is less sensitive than serology and has technical sampling errors.
Confirming Eradication of HP after Antibiotic Therapy
We recommend that HP eradication after appropriate antibiotic therapy be confirmed with C14-urea breath testing (C14-UBT).
Recommendations for C14-UBT testing:
- Wait for at least 6 weeks after eradication therapy completed
- Cease acid-suppressing agents for 1 week before C14-UBT
- Fast overnight before test
While faecal HP antigen testing has been advocated as a replacement for the C14-UBT to confirm eradication, there is sufficient controversy surrounding the sensitivity and specificity of the faecal test to recommend against its diagnostic use at this time.
References
- Leong VK, Sung JJ. Diagnosis of Helicobacter pylori infection. J. Int. Fed. Clin. Chem. 1996, 8(4):161-166
- Makristathis A, Pasching E, Schutze K, et al. Detection of Helicobacter pylori in stool specimens by PCR and antigen enzyme immunoassay. J. Clin. Microbiol. 1998, 36(9):2772-2774
- Vaira D. et al. Diagnosis of HP infection with new non-invasive antigen-based assay. Lancet 1999, 354:30-33
- Trevisiani L et al. Detection of HP in faeces by a new EIA method: preliminary results. Scand. J. Gastroenterol. 1998, 33:893-4
- Plebani M et al. Letter to Lancet. 1999, 354:9185
Written by: Dr Glenn Reeves, Immunology HAPS
Written: January 2000
Last Reviewed: 10.5.2001
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