Helicobacter pylori Noninvasive Testing

Aka: Helicobacter pylori Noninvasive Testing, H. pylori IgG, H. pylori Serology, H. pylori ELISA

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II. Indications

  1. Dyspepsia evaluation

III. Precautions

  1. Stop Antibiotics for 4 weeks before Helicobacter Pylori testing
  2. Stop Proton Pump Inhibitors (PPIs) for 2 weeks before Helicobacter Pylori testing
  3. Only Serology and Rapid Urease Test are not affected by Antibiotics and PPIs

IV. Labs: First-Line Helicobacter Pylori tests

  1. Urea Breath Test (Carbon 13)
    1. Test Sensitivity: 96 to 100%
    2. Test Specificity: 93 to 100%
    3. Likelihood: LR+ 12, LR- 0.05
    4. Requires Fasting for 6 hours, no PPI for 2 weeks before test, and expensive
    5. Ferwana (2015) World J Gastroenterol 21(4): 1305-14 [PubMed]
  2. Stool monoclonal Antigen tests (HpSA enzyme immunoassay)
    1. Test Sensitivity: 92-94%
    2. Test Specificity: 94-97%
    3. Likelihood: LR+ 24, LR- 0.7
    4. Most accurate, but more expensive than immunochromatography
    5. Gisbert (2006) Gastroenterol 101(8): 1921-30 [PubMed]
  3. Stool monoclonal Antigen tests (HpSA Immunochromatography, older methodology)
    1. Test Sensitivity: 69-87%
    2. Test Specificity: 87-93%
    3. Variable reliability, but available for office based testing

V. Labs: Other Helicobacter PyloriAntibody or Antigen testing

  1. IgG testing may be positive for years after eradication
    1. Indicated only for initial diagnosis
    2. Does not differentiate current active infection from prior infection
    3. Not used to confirm H. pylori cure
  2. Reference lab Serology (ELISA for H. pylori IgG)
    1. Test Sensitivity: 85-93%
    2. Test Specificity: 79-96%
    3. Likelihood: LR+ 2.8, LR- 0.2
  3. Office-based lab whole blood Serology (ELISA for IgG)
    1. Test Sensitivity: 50-85%
    2. Test Specificity: 75-100%
  4. Urine ELISA for H. pylori IgG
    1. Test Sensitivity: 70-96%
    2. Test Specificity: 77-85%
  5. Saliva ELISA for H. pylori IgG
    1. Test Sensitivity: 82-91%
    2. Test Specificity: 71-85%

VI. Other Testing: String Test

  1. Mechanism
    1. Polymer string is swallowed
    2. String is recovered and run for PCR or culture
  2. Accuracy
    1. Test Sensitivity: 75-80%
    2. Test Specificity: 75-100%

VII. Advantages

  1. Noninvasive procedure

VIII. Disadvantages

  1. Tests do not confirm cure after H. Pylori Management
  2. Cure confirmation is only by the following tests
    1. Urea Breath Test
    2. H. pylori Stool Antigen (HpSA)
    3. Endoscopic Biopsy for H. pylori

IX. References

  1. Calvet (2009) Clin Infect Dis 48(10): 1385-91 +PMID:19368506 [PubMed]
  2. Hahn (2000) Gastrointest Endosc 52(1):20-6 [PubMed]
  3. Ho (2000) Gastroenterol Clin North Am 29(4):853-62 [PubMed]
  4. Meurer (2002) Am Fam Physician 65(7):1327-39 [PubMed]
  5. Snyder (1999) Can J Gastroenterol 13:585-9 [PubMed]

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