The role and diagnostic value of the most common methods for diagnosing Helicobacter pylori infection

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Abstract

The purpose of the study was to identify and evaluate the practical value of the most common diagnostic methods for Helicobacter pylori infection in patients with chronic inflammation of the gastric mucosa.

Materials and methods. The study involved 104 people. All the patients examined underwent esophagogastroduodenoscopy with a rapid urease histochemical test for Helicobacter pylori and a standard five-point biopsy of the gastric mucosa for morphological evaluation and bacterioscopy. If the result of the quick urease histochemical test coincided with the data of the biopsy study on Helicobacter pylori, no further examination was carried out. In case of discrepancy the patients additionally underwent the 13C-urease breath test.

Results. It was found that the sensitivity of the rapid urease histochemical test in the area of the proposed model, according to our study, was 89.74% and the specificity was 46.15% when validating it using the additional methods. Similar calculations for the diagnostic method of staining by Giemsa showed sensitivity of 100% and specificity of 97.4%. The total number of the infected in the survey was 78 out of 104 people, which amounted to 75%.

When analysing the severity of activity, inflammation and atrophic changes in the gastric mucosa, it was found that in the patients with two positive tests, the severity of the processes was significantly higher than in those with one positive test or all the tests were negative (p < 0.05). When comparing the same processes in cases where only a quick urease histochemical test was positive and no signs of Helicobacteriosis were detected in any test, no significant differences were detected.

Discussion. The rapid urease histochemical test showed good sensitivity of 89.74%, but unsatisfactory specificity of 46.15%, which severely limits its use. An unexpected result for this methodology was a large number of false positive tests, while the European recommendations indicate a more frequent occurrence of false negative results, which can be explained by differences in the production technology of the test systems. High sensitivity and specificity of the Helicobacter pylori test using Giemsa staining strongly depends on observing the methodology and experience of a specialist and cannot be recommended as a standard in the routine medical use.

The study confirmed the recommendations for using at least two diagnostic tests to diagnose the infection, while the most common rapid urease histochemical test always needs confirmation. As a result of the analysis, it can be said that esophagastroduodenoscopy with a rapid urease histochemical test for Helicobacter pylori and standard diagnostic biopsy is the optimal method for diagnosing the pathology of the “upper” sections of the gastrointestinal tract. Moreover, 13C-UDT seems to be almost ideal as a screening technique and for evaluating treatment in cases where endoscopic monitoring is not necessary.

About the authors

Alexander V. Tryapitsyn

Saint Petersburg State University Hospital

Author for correspondence.
Email: tryapitsyn@gmail.com

Candidate of Medical Sciences, doctor of gastroenterologist of the outpatient department

Russian Federation, 154, Fontanka riv. emb., Saint-Petersburg, 190103

Vladimir A. Mal’kov

Saint Petersburg State University Hospital

Email: wladimir.malkow@gmail.com

Head of Endoscopy Department

Russian Federation, 154, Fontanka riv. emb., Saint-Petersburg, 190103

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2. The severity of inflammation, activity and atrophy in the groups: RUHcT — a rapid urease histochemical test; HEBs — histological examination of the biopsy specimens; 13C-UBT — 13C-urease breath test; “+” — a positive test; “–” — negative test; n — number of patients

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Copyright (c) 2020 Tryapitsyn A.V., Mal’kov V.A.

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