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Korean J Gastroenterol  <  Volume 72(5); 2018 <  Articles

The Korean Journal of Gastroenterology 2018; 72(5): 229-236  https://doi.org/10.4166/kjg.2018.72.5.229
Diagnosis of Helicobacter pylori Infection
Cheal Wung Huh, Byung-Wook Kim
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Byung-Wook Kim
Received: September 9, 2018; Revised: September 17, 2018; Accepted: September 17, 2018; Published online: November 25, 2018.
© The Korean Journal of Gastroenterology. All rights reserved.

Abstract
Accurate diagnosis of Helicobacter pylori (H. pylori) infection is mandatory for the effective management of many gastroduodenal diseases. Currently, various diagnostic methods are available for detecting these infections, and the choice of method should take into account the clinical condition, accessibility, advantage, disadvantage, as well as cost-effectiveness. The diagnostic methods are divided into invasive (endoscopic-based) and non-invasive methods. Non-invasive methods included urea breath test, stool antigen test, serology, and molecular methods. Invasive methods included endoscopic imaging, rapid urease test, histology, culture, and molecular methods. In this article, we provide a review of the currently available options and recent advances of various diagnostic methods.
Keywords: Helicobacter pylori; Diagnosis; Guideline
Figures
Fig. 1. Rapid urase test. When Helicobacter pylori produce ammonia then pH will increase and the color of the medium will change from yellow to red.
Fig. 2. Giemsa stain. The Helicobacter pylori organisms (arrows) are present in Giemsa stain (×400).
Tables

Overview of Diagnostic Methods

Characteristics Advantages Limitations
Non-invasive
UBT Sensitivity: >95%
Specificity: >95%
i) High sensitivity and specificity
ii) Cheap, simple, safe, widely available
iii) Useful to confirm H. pylori eradication
iv) No sampling errors
i) No data about antibiotic resistance
ii) Special equipment required
iii) False negative results in the case of PPI and antibiotics
SAT Sensitivity: >95%
Specificity: >95%
i) High sensitivity and specificity
ii) Cheap, simple, safe
iii) Practically useful for children
iv) No need to skilled staffs
i) No data about antibiotic resistance
ii) Patient reluctance
iii) False negative results in the case of PPI and antibiotics
iv) Variation in sensitivity and specificity over the different clinical circumstances
Serology Sensitivity: >95%
Specificity: 60-90%
i) Cheap, simple, safe
ii) Not affected by gastroduodenal bleeding
iii) No false negative result in the case of PPI and ntibiotics
iv) Identifies virulence factors
i) No data about antibiotic resistance
ii) Failure in distinguish between active and past infection
iii) Not useful to confirm H. pylori eradication
Invasive
RUT Sensitivity: 90%
Specificity: >95%
i) High sensitivity and specificity63
ii) Cheap, simple, rapid
iii) Practically useful in a clinical setting
i) No data about antibiotic resistance
ii) Sampling errors
iii) False negative results in the case of PPI, antibiotics and gastroduodenal bleeding
Histology Sensitivity: 60-90%
Specificity: >95%
i) Gold standard for direct H. pylori detection
ii) Secondary diagnostic information
iii) Cheap, simple
i) No data about antibiotic resistance
ii) Sampling errors
iii) High inter-observer variability
iv) Time-consuming
Culture Sensitivity: 50-90%
Specificity: 100%
i) Antibiotics sensitivity profiling
ii) The most specific method
i) Limited availability, technically challengingmethod
ii) Time-consuming, expensive method
iii) False negative results in the case of PPI, antibiotics and gastroduodenal bleeding
Molecular method Sensitivity: >95%
Specificity: >95%
i) Antibiotics sensitivity profiling
ii) High sensitivity and specificity
iii) Useful to detect the mutations and virulence factors
iv) Quick and accurate result
i) Expensive
ii) Limited availability
iii) Risk of contamination

UBT, urea breath test; H. pylori, Helicobacter pylori; PPI, proton pump inhibitor; SAT, stool antigen test; RUT, rapid urease test.

Recommended Diagnostic Method for Helicobacter pylori in Recent Guidelines

Initial diagnosis Follow up after eradication

Non-invasive Invasive Non-invasive Invasive




UBT SAT Serology RUT Histology Culture UBT SAT Serology RUT Historology Culture
Maastricht V/Florence Consensus (2017)1 O O O O O O O O
Korean College of Helicobacter and Upper Gastrointestinal Research (2013)42 O O O O O O O O O
Japanese Society of Helicobacter Research (2013)69 O O O O O O O O O O O O

UBT, urea breath test; SAT, stool antigen test; RUT, rapid urease test.

Diagnostic Options of Helicobacter pylori Infection in Different Clinical Circumstances

Upper GIbleeding Postgastrectomy Post eradication therapy
Non-invasive
 UBT + - ++
 SAT - - ++
 Serology ++ - -
Invasive
 RUT - + +
 Histology + ++ ++
 Culture - - -
 Molecular method ++ + ++

GI, gastrointestinal; UBT, urea breath test; SAT, stool antigen test; RUT, rapid urease test.

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