Combined Rapid Urease Test and Histology For The Diagnosis of Helicobacter Pylori Infection
Virgilio S. Lo Jr., Carmelita D. Dado-Dalupang
Dec 2022 DOI 10.35460/2546-1621.2022-sp10 Access
Abstract
Significance: Accurate detection of Helicobacter pylori (HP) is essential for the diagnosis of HP infection. The use of antibiotics and proton pump inhibitors (PPI) may result in false-negative rapid urease test (RUT) results. We aimed to determine the sensitivity and specificity of RUT compared with histology and assess the detection rate of combined RUT and histology for HP infection.
Methodology: Retrospective data collection was performed on 192 patients who were tested for both RUT and histology at the time of upper endoscopy from 2017 to 2018. At least two gastric biopsies (1 from corpus, 1 from antrum) were taken each for RUT and histology. The endoscopy was performed by a single gastroenterologist and a single pathologist was responsible for interpreting the histology with hematoxylin and eosin (H&E) and Giemsa stain. The gold standard test for the diagnosis of HP infection was histology. Demographic profile, RUT and histology results were reviewed. Tests for diagnostic accuracy were computed using SPSSv23.
Results: 192 patients were tested for RUT and histology. 52(27.1%) were males and 140(72.9%) were females with a mean age of 54±17 years. Epigastric pain was the most common indication (42.7%). 24(12.5%) patients tested positive for HP infection. Among these; 16(8.3%) tested positive for both RUT and histology(true-positive), while 8(4.2%) tested negative for RUT but had positive histology(false-negative). 6 out of 8(75%) patients with false negative results had PPI use. The sensitivity and specificity of RUT for the diagnosis of HP infection were 66.7 and 98.2%, respectively. While the positive and negative likelihood ratio were 37.3 and 0.34, respectively with a diagnostic odds ratio of 110.
Conclusion: The HP detection rate of RUT combined with histology increased by 33% compared with RUT alone. RUT is a highly specific test for diagnosing HP infection. Given its modest sensitivity, histology plays an important role in the diagnosis of HP infection, especially in patients taking PPIs. We recommend doing histology when RUT is negative to increase the HP detection rate.
Key words: retrospective, helicobacter pylori, rapid urease test, histology, RUT, giemsa stain
- Patel SK, Pratap CB, Jain AK, Gulati AK, Nath G. Diagnosis of Helicobacter pylori: what should be the gold standard? World J Gastroenterol [Internet]. 2014;20(36):12847–59. Available from: http://dx.doi.org/10.3748/wjg.v20.i36.12847
- McColl KEL. Clinical practice. Helicobacter pylori infection. N Engl J Med [Internet]. 2010;362(17):1597–604.Available from: http://dx.doi.org/10.1056/NEJMcp1001110
- Yakoob J, Jafri W, Abid S, Jafri N, Abbas Z, Hamid S, et al. Role of rapid urease test and histopathology in the diagnosis of Helicobacter pylori infection in a developing country. BMC Gastroenterol [Internet]. 2005;5(1):38. Available from: http://dx.doi.org/10.1186/1471-230X-5-38
- Uotani T, Graham DY. Diagnosis of Helicobacter pylori using the rapid urease test. Ann Transl Med [Inter net]. 2015;3(1):9. Available from: http://dx.doi. org/10.3978/j.issn.2305-5839.2014.12.04
- Feldman, M, Friedman, L, Brandt, L. Sleisenger and Fordtran’s Gastrointestinal and Liver Diseases. 11th ed. Phi ladelphia PA: Elsevier; 2020. 2488 p
- Lee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med [Internet]. 2015;3(1):10. Available from: http://dx.doi.org/10.3978/j.issn.2305-5839.2014.11.03
- Fennerty MB. A review of tests for the diagnosis of Helicobacter pylori infection. Lab Med [Internet]. 1998;29(9):561–6. Available from: http://dx.doi.org/10.1093/labmed/29.9.561
Articles related to the one you are viewing
There are currently no results to show, please try again later
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.