Helicobacter pylori infection diagnostic test

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Nonendoscpic diagnostic studies

Antibody testing is inexpensive and widely available but poor PPV in populations with a low prevalence of H. pylori infection limits its usefulness in clinical practice.

The UBTs and fecal antigen tests provide reliable means of identifying active H. pylori infection before antibiotic therapy.

The UBT is the most reliable nonendoscopic test to document eradication of H. pylori infection.

The monclonal fecal antigen test provides another nonendoscopic means of establishing H. pylori cure after antibiotic treatment.

Testing to prove H. pylori eradication appears to be most accurate if performed at least 4 wk after the completion of antibiotic therapy.

The nonendoscopic diagnostic testing methods for H.pylori include:

• Antibody tests
• Urea breath test
• Fecal antigen test

Antibody tests

• Antibody testing depends on the detection of H.pylori specific IgG antibodies in serum, whole blood, or urine.
• The IgG antibodies typically become detected 21 days after infection and can remain present long after eradication.
• Antibodies are detected using enzyme-linked immunosorbent assay (ELISA) and latex agglutination techniques.

Urea Breath Tests

• Urea breath test identifies active H.pylori infection.
• Procedure

• The urea labeled with either the nonradioactive isotope 13C or the radioactive isotope 14C is ingested.
• The H.pylori urease converts labeled urea to CO2, which can be quantitated in expired breath.

• 13C labeled urea is preferred in children and pregnant females.
• Urea breath test has 95% sensitivity and specificity.
• This test is an accurate means of post-treatment testing.
• As this test mainly depends on urease activity of H.pylori, the sensitivity of test is decreased by medications such as bismuth containing products, PPIs and antibiotics as they reduce organism density or urease activity. It is recommended to with hold PPIs for 7-14 days prior to test, and bismuth and antibiotics are withheld for at least 28days.
• Antacids do not affect the efficacy of the test.