Evaluation of Invasive and Non-Invasive Methods for the Diagnosis of H. pylori in Dyspepsia Patients

Abstract

Background: H. pylori has been established as the major causative agent of chronic gastritis, and represents the main etiological cause of other gastroduodenal diseases such as peptic ulceration, gastric lymphoma, and gastric cancer. Therefore, screening and treatment of the bacterium is an important strategy for preventing gastric cancer. Objective: To compare some invasive classical histological tests to non-invasive serological antibody and stool antigen tests for the diagnosis of H. pylori infections. Patients and Methods:The study population comprised of 171 patients with symptoms of dyspepsia and other gastritis related symptoms. Three biopsy specimens were taken and collected from the stomach and sent for histopathologic study. H and E staining and modified Giemsa staining were performed on tissue sections of each case. Serology antibody and Stool antigen tests were also used as nan-invasive tests in this study. Results: Four tests had been done to detect the presence of H. pylori Bacteria. The mean age (+ SD) of the studied sample was 43.8 + 14.7 years, ranging from 20 to 74 years. The median was 44 years. The total agreement between the serum Ab test and the stool Ag test was 88.3%. Significant differences were detected between the two tests (p < 0.001). It is evident that the serum Ab test is highly sensitive (sensitivity = 98.4%), but the Predictive value positive (76.3%) was not so high. The Giemsa test was highly specific (specificity = 98.2%), and highly sensitive (sensitivity = 93.5%). Conclusion: The main advantage of histopathology tests is not only restricted to detection purpose, it also can detect any abnormalities of gastric mucosa by bacteria such as peptic ulcer bleeding, atrophic gastritis, intestinal metaplasia, and gastric cancer. The modified Giemsa staining method could be used as a method of choice for the detection of H. pylori due to its sensitivity, simplicity and consistency.

Keywords

• H. pylori, gastritis, peptic ulcer, histology, H & E, Giemsa, Stool Ag and serum Ab test