H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in Dyspeptic Patients
Introduction: There are several invasive and non-invasive techniques used to diagnose H. pylori infection, each having its own advantages and disadvantages. Invasive methods require biopsy samples from stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture and Polymerase chain reaction (PCR) whereas non-invasive tests include stool antigen test, serology and Urea breath test
Objectives: To determine the diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients (18-65 years).
Materials & Methods: Descriptive, cross-sectional study was conducting during 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender having age 18-65 years having symptoms of dyspepsia were included. Patients having gall stones, celiac disease, pancreatic disease, Diabetes Mellitus, thyroid disease and any other patients on PPI or H2 receptors. Patients with history of alcoholism, diagnosed cases of H. Pylori infection or treatment history of H Pylori. Patients diagnosed for pancreatitis, cholecystitis, Hepatitis B or C Virus positive cases of Chronic Liver Diseases, HIV, malignancy or Ischemic Heart Disease or being pregnant were excluded. H. Pylori on Fecal Antigen Detection and endoscopic biopsy were noted.
Results: Fecal Antigen Detection found that 42 were True Positive and 04 were False Positive. Among 39, Fecal Antigen negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients was 91.30%, 89.74%, 91.30%, 89.74% and 90.59% respectively.
Conclusion: This study concluded that diagnostic accuracy of H. Pylori Fecal Antigen Detection in dyspeptic Patients is quite high.
Keywords: helicobacter pylori, Fecal Antigen Detection, endoscopic biopsy.
2. Ayana SM, Swai B, Maro VP. Upper gastrointestinal endoscopic findings and prevalence of Helicobacter pylori infection among adult patients with dyspepsia in northern Tanzania. Tanzan J Health Res. 2014;16(1):16–22
3. Korkmaz H, Kesli R, Karabagli P, Terzi Y. Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection. Helicobacter. 2013;18(5):384-91.
4. Watanabe K, Nagata N, Shimbo T, Nakashima R, Furuhata E, Sakurai T, et al. Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training. BMC Gastroenterol. 2013;13:128.
5. Khan A, Faroooqui A, Raza Y, Rasheed F, Manzoor H, Akhtar SS, et al. Prevalence, diversity and disease association of Helicobacter pylori in dyspeptic patients from Pakistan. J Infect Dev Ctries. 2013;7(3):220-8.
6. Khan MU, Yasrul AB, Ahmed S, Munir R, Atif G, Tahir M, et al. Prevalence of Helicobacter pylori infection in Pakistan Population. Res J Pharma Technol. 2017;10;12-9.
7. Korkmaz H, Findik D, Ugurluoglu C, Terzi Y. Reliability of stool antigen tests: investigation of the diagnostic value of a new immunochromatographic Helicobacter pylori approach in dyspeptic patients. Asian Pac J Cancer Prev. 2015;16(2):657-60.
8. Patel SK, Pratap CB, Jain AK, Gulati AK, Nath G. Diagnosis of Helicobacter pylori: what should be the gold standard. World J Gastroenterol. 2014;20(36):12847–859.
9. Uotani T, Graham DY. Diagnosis of Helicobacter pylori using the rapid urease test. Ann Translational Med. 2015;3:23-31.
10. Kusters JG, van Vliet AHM, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clinical Microbiology Reviews. 2006;19(3):449–490.
11. Smolka AJ, Schubert ML. Helicobacter pylori-induced changes in gastric acid secretion and upper gastrointestinal disease. Current Topics in Microbiology and Immunology. 2017;400:227–252.
12. Camilo V, Sugiyama T, Touati E. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2017;22
13. Testerman TL, Morris J. Beyond the stomach: an updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World Journal of Gastroenterology. 2014;20(36):12781–12808.
14. Abadi ATB. Strategies used by helicobacter pylori to establish persistent infection. World Journal of Gastroenterology. 2017;23(16):2870–2882.
15. McMahon BJ, Bruce MG, Koch A. The diagnosis and treatment of Helicobacter pylori infection in Arctic regions with a high prevalence of infection: Expert Commentary. Epidemiology and Infection. 2016;144(2):225–233.
16. Vaira D, Malfertheiner P, Mégraud F, Axon AT, Deltenre M, Hirschl AM, Gasbarrini G, O’Morain C, Garcia JM, Quina M, et al. Diagnosis of Helicobacter pylori infection with a new non-invasive antigen-based assay. HpSA European study group. Lancet. 1999;354:30–33.
17. Perri F, Manes G, Neri M, Vaira D, Nardone G. Helicobacter pylori antigen stool test and 13C-urea breath test in patients after eradication treatments. Am J Gastroenterol. 2002;97:2756–2762.
18. Gisbert JP, 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;101:1921-30.
19. Raguza D, Machado RS, Ogata SK, Granato CF, Patrício FR, Kawakami E. Validation of a monoclonal stool antigen test for diagnosing Helicobacter pylori infection in young children. J Pediatr Gastroenterol Nutr 2010;50:400-3.
20. Hasosah M. Accuracy of invasive and noninvasive methods of Helicobacter pylori infection diagnosis in Saudi children. Saudi J Gastroenterol 2019;25:126-31.
21. Gisbert JP, 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.
22. Calvet X, Lario S, Ramírez-Lázaro MJ, Montserrat A, Quesada M, Reeves L, Masters H, Suárez-Lamas D, Gallach M, Miquel M. Accuracy of monoclonal stool tests for determining cure of Helicobacter pylori infection after treatment. Helicobacter. 2010;15:201-205.
23. Zhou X, Su J, Xu G, Zhang G. Accuracy of stool antigen test for the diagnosis of Helicobacter pylori infection in children: a meta-analysis. Clin Res Hepatol Gastroenterol. 2014;38:629-638.
24. Korkmaz, H, Kesli R, Karabagli P, Terzi Y. Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection. Helicobacter 2013;18, 384–391.
25. Zhou X, Su J, Xu G, Zhang G. Accuracy of stool antigen test for the diagnosis of Helicobacter pylori infection in children: A meta-analysis. Clin. Res. Hepatol. Gastroenterol. 2014;38:629–638.
26. Gisbert JP, Cabrera MMM, Pajares JM. Stool antigen test for initial Helicobacter pylori diagnosis and for confirmation of eradication after therapy. Med. Clin. (Barc). 2002;118:401–4.
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