Stool Antigen Test in Diagnosis of Helicobacter Pylori Infection Is it enough?

Öz

Objective: Invasive and non-invasive tests are available for the diagnosis of Helicobacter pylori (Hp) infection. Among these tests, endoscopic biopsy is the gold standard. In this study; We aimed to compare the specificity and sensitivity of stool antigen test used in the diagnosis of Hp with gastric endoscopic biopsy. Materials and Methods: A total of 220 patients who applied to the Internal Medicine outpatient clinic of Health Sciences University Tepecik Training and Research Hospital with dyspeptic complaints between January 2016 and April 2018 were retrospectively screened. Of these; 74 patients who underwent stool antigen and endoscopic biopsy for the diagnosis of simultaneous Hp, and who did not receive antibiotics and proton pump inhibitors between diagnostic tests were included in the study. Results: While endoscopic biopsy was positive in 42 (93.3%) of 45 patients with positive stool Hp antigen; In 3 (10.3%) of 29 patients who were found to be negative for Hp antigen in the stool, Hp was positive in endoscopic biopsy. When compared with endoscopic biopsy, the sensitivity of Hp antigen in stool was 93.3%, specificity 89.6%, positive predictive value 93.3% and negative predictive value 89.6%. The sensitivity of the kit in the detection of Hp is considered to be over 94%. In this study, the results were similar (93.3%). Conclusion: In cases with dyspeptic complaints and no suspected malignancy, stool antigen test can be safely performed instead of endoscopy for the diagnosis of Hp.

Anahtar Kelimeler

• Helicobacter Pylori
• Antigen
• Endoscopy
• Dyspepsia

Gaitada Antijen Testi Helikobakter Pilori Enfeksiyonu Tanısında Yeterli midir?

Öz

Giriş ve Amaç: Helikobakter pilori (Hp) enfeksiyonu tanısında invaziv ve non-invaziv testler mevcuttur. Bu testler içerisinde endoskopik biopsi altın standarttır. Bu çalışmada; Hp tanısında kullanılan gaitada antijen testinin özgüllük ve duyarlılığını mide endoskopik biopsisi ile karşılaştırmayı amaçladık. Gereç ve Yöntemler: Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma hastanesi iç hastalıkları polikliniğine Ocak 2016-Nisan 2018 tarihleri arasında dispeptik şikayetler ile başvuran toplam 220 hasta geriye dönük taranmıştır. Bu hastalardan; eşzamanlı Hp tanısı için gaitada antijen ve endoskopik biopsi yapılan, her iki tanı testi arasında antibiyotik ve proton pompa inhibitörü almamış olan 74 hasta çalışmaya dahil edilmiştir. Bulgular: Gaitada Hp antijeni pozitif saptanan 45 hastanın 42 (%93,3)’sinde endoskopik biopsi pozitif iken; gaitada Hp antijeni negatif saptanan 29 hastanın 3 (%10,3)’ünde endoskopik biopside Hp pozitif saptandı. Endoskopik biopsi ile karşılaştırıldığında gaitada Hp antijeninin duyarlılığı %93.3, özgüllüğü %89,6, pozitif prediktif değeri %93,3, negatif prediktif değeri %89,6 olarak bulunmuştur. Hp tespitinde kitin duyarlılığı %94’ün üzerinde kabul edilmektedir. Bu çalışmada da sonuçlar benzerdir (%93,3). Sonuç: Dispeptik şikayetleri olan ve maligniteden şüphelenilmeyen durumlarda Hp tanısı için endoskopi yerine gaitada antijen testi güvenle bakılabilir.

Anahtar Kelimeler

• helikobakter
• antijen,
• endoskopi
• dispepsi

Kaynakça

1. Tekin, F, Günşar, F, Karasu, Z, et al., Analysis of frequency of duodenal and gastric ulcer patients and frequency of Helicobacter pylori in these cases according to each year: A 10-year retrospective analysis, Akademik Gastroentroloji Dergisi, 2008, 7(1), 30-33.
2. Malfertheiner, P, Megraud, F, O’Morain, C.A, et al., Management of Helicobacter infection-the Maastricht V/Florence Consensus Report, Gut, 2017, 66, 6-30.
3. Zagari, R.M, Romiti, A, Ierardi E, et al., The “three-in-one” formulation of bismuth quadruple therapy for Helicobacter pylori eradication with or without probiotics supplementation: Efficacy and safety in daily clinical practice, Helicobacter, 2018, 23, 59-65.
4. Fiorini, G, Zullo, A, Saracino, I.M, Gatta, L, Pavoni, M, Vaira, D, Pylera and sequential therapy for first-line Helicobacter pylori eradication: a culture-based study in real clinical practice, European Journal of Gastroenterology & Hepatology, 2018, 30, 621-625.
5. Zhang, M, Zhou, Y.Z, Li, X.Y, Tang, Z, Zhu, H.M, Yang, Y, Chhetri, J.K, Seroepidemiology of Helicobacter pylori infection in elderly people in the Beijing region, China, World Journal of Gastroenterology, 2014, 20(3), 635–639.
6. Chen, H.L, Chen, M.J, Shih, S.C, Wang, H.Y, Lin, I.T, Bair, M.J, Socioeconomic status, personal habits, and prevalence of Helicobacter pylori infection in the inhabitants of Lanyu, Journal of the Formosan Medical Association, 2014, 113, 278–283.
7. Den Hollander, W.J, Holster, I.L, Van Gilst, B, Van Vuuren, A.J, Jaddoe, V.W, Hofman, et al., Intergenerational reduction in Helicobacter pylori prevalence is similar between different ethnic groups living in a Western city, Gut, 2015, 64, 200–208.
8. Uyanık, M, Hamidullah, M, Aktaş, O, Helicobacter pylori’nin mikrobiyolojik tanısı, The Eurasian Journal of Medicine, 2007, 39 (3) 205-9.

9. 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, American Journal of Gastroenterology, 2006,101,1921-1930.
10. Nguyen, T.V, Bengtsson, C, Nguyen, G.K, Granström, M, Evaluation of a novel monoclonal-based antigen-in-stool enzyme immunoassay (Premier Platinum HpSA PLUS) for diagnosis of Helicobacter pylori infection in Vietnamese children, Helicobacter, 2008, 3, 269-273.
11. Kaklıkkaya, N, Çubukçu, K, Yazıcı, Y, et al., Gastrointestinal yakınması olan hastalarda gram boyama, üreaz ve kültür testleri ile Helicobacter pylori varlığının belirlenmesi, İnfeksiyon Dergisi, 2003, 17(3), 329-32.
12. Aktepe OC, Ciftçi IH, Safak B, Uslan I, Dilek FH. Five methods for detection of Helicobacter pylori in the Turkish population. World Journal of Gastroenterology, 2011, 17(47), 5172-6.
13. Özçay, F, Koçak, N, Temizel I.N, et al., Helicobacter pylori infection in Turkish children: comparison of diagnostic tests, evaluation of eradication rate, and changes in symptoms after eradication, Helicobacter, 2004, 9(3), 242-8.