Laboratory diagnosis of H. Pylori infection, Ola Elgaddar
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Transcript of Laboratory diagnosis of H. Pylori infection, Ola Elgaddar
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Laboratory Diagnosis of
H. Pylori Infection
Ola H. Elgaddar MD, PhD, CPHQ, LSSGB
Lecturer of Chemical Pathology
Alexandria University
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Prevalence of H. pylori infection
The Helicobacter Foundation, 2014
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Gram –ve Bacteria
Colonizes 50% of the
world population
Virulent strains may
cause gastritis, ulcers,
adenocarcinoma & gastric
mucosa-associated
lymphoid tissue (MALT)
lymphoma
Class I carcinogen
(WHO).
Formichella et al. Clin Vaccine Immunol 2013; 20: 1703-10
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Diagnosis of H. Pylori
INVASIVE NON
INVASIVE
Histopathology
Rapid Urease Test
Culture
PCR
Urea Breath Test
Stool Ag
Serology
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Diagnostic Performance
Denise et. al. Nature Reviews Nephrology 2014; 10: 215–25.
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Non – Invasive Tests
1) Urea (14C) Breath Test
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Non – Invasive Tests 1) Urea (14C) Breath Test
95% Sensitivity, 100% Specificity,
100% PPV, 96 % NPV
Ideal for monitoring therapeutic outcomes
Patients not on PPI for 1 week
Petrovic et.al. Hell J Nucl Med 2011; 14: 21–4.
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Non – Invasive Tests 2) Stool Monoclonal Ag
Performance differs
according to reagents
88% Sensitivity, 98% Specificity,
88% PPV, 98 % NPV
FDA approved for therapeutic monitoring
Confirm eradication after 4-8W. of Rx
Not affected by PPIs
Calvet et. al. Helicobacter 2010; 15: 201–5.
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Non – Invasive Tests 3) Serology (IgG / AgA)
Either Abs against
whole bacterial cell or
against specific proteins
Good negative test
Not all H. pylori-infected subjects develop
disease.
It depends on the strain heterogeneity
based on the expression of certain
virulence factors, Garza-Gonzalez et.al. World J Gastroenterol 2014; 20: 1438-49.
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Non – Invasive Tests 3) Serology
Six highly immunogenic virulence factors,
CagA (Cytotoxin-associated-gene A),
VacA (Vacuolating Cytotoxin A), GroEL,
gGT, HcpC, and UreA, are currently being
detected.
Most of them are present in all strains but
expressed only in certain ones.
97.6% Sensitivity and 96.2% Specificity;
much higher than whole cell Abs
Garza-Gonzalez et.al. World J Gastroenterol 2014; 20: 1438-49.
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Invasive Tests
Kanna et. al. Gastroenterology and Endoscopy news 2013 (e-published)
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