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False negative h pylori blood test. Helicobacter Pylori Testing: Methods, Accuracy, and Considerations

by alexxlab

How is Helicobacter pylori testing performed. What are the available non-invasive testing methods for H. pylori. What factors can affect the accuracy of H. pylori tests. When should patients undergo H. pylori testing.

Understanding Helicobacter Pylori and Its Health Implications

Helicobacter pylori (H. pylori) is a bacteria found in the stomach that can lead to various gastrointestinal disorders. Discovered in 1982, this microorganism has been linked to conditions such as chronic gastritis, gastric ulcers, and dyspepsia. H. pylori infection can cause significant discomfort and, if left untreated, may lead to more serious health complications.

How does H. pylori affect the digestive system? The bacteria can weaken the protective mucous coating of the stomach and small intestine, allowing stomach acid to irritate the sensitive lining beneath. This process can result in ulcers, inflammation, and other digestive issues.

Common Symptoms of H. pylori Infection

  • Abdominal pain or discomfort
  • Bloating
  • Nausea
  • Loss of appetite
  • Frequent burping
  • Unintentional weight loss

Given the potential health risks associated with H. pylori infection, accurate diagnosis is crucial. Let’s explore the various testing methods available for detecting this bacteria.

Non-Invasive H. pylori Testing Methods

For patients without “alarm” symptoms such as significant weight loss or vomiting, non-invasive testing methods are often the first line of approach for diagnosing H. pylori infection. These tests are generally easy to perform and provide reliable results.

Urea Breath Test: A Gold Standard in H. pylori Detection

The urea breath test is a widely used and highly accurate method for diagnosing H. pylori infection. How does this test work? It relies on the unique ability of H. pylori to convert urea into carbon dioxide and ammonia.

During the test, patients ingest a compound containing a detectable carbon isotope. If H. pylori is present in the stomach, it will break down this compound, releasing the isotope in the form of carbon dioxide, which can then be detected in the patient’s breath.

Types of Urea Breath Tests

  1. Radioactive isotope test
  2. Non-radioactive isotope test

Is the radioactive test safe? The amount of radiation used in the radioactive isotope test is minimal, comparable to the natural radiation exposure in daily life. However, for those concerned about radiation exposure, the non-radioactive test offers an equally effective alternative.

Accuracy of Urea Breath Tests

How reliable are urea breath tests? These tests boast an impressive sensitivity and specificity of 95%, meaning they have a very low chance of producing false positive results. This high accuracy makes the urea breath test a preferred method for many healthcare providers.

Factors Affecting H. pylori Test Accuracy

While urea breath tests are highly accurate, certain factors can influence their results. Understanding these factors is crucial for both healthcare providers and patients to ensure reliable test outcomes.

Medications That Can Affect Test Results

  • Antibiotics
  • Proton Pump Inhibitors (PPIs)

How do these medications impact test results? Both antibiotics and PPIs can suppress H. pylori in the stomach without completely eliminating it. This suppression can lead to false negative results, where the test fails to detect an existing infection.

Recommended Medication Discontinuation Periods

  • Antibiotics: 4 weeks prior to testing
  • PPIs: 2 weeks prior to testing

Adhering to these discontinuation periods is essential for obtaining accurate test results. Patients should consult their healthcare provider before stopping any prescribed medications.

H. pylori Stool Antigen Test: An Alternative Non-Invasive Method

Another non-invasive option for detecting H. pylori is the stool antigen test. This method looks for specific markers of active H. pylori infection in a patient’s stool sample.

Comparing Stool Antigen Test to Urea Breath Test

How does the stool antigen test compare to the urea breath test in terms of accuracy? The stool antigen test offers similar accuracy in detecting H. pylori infection. However, it has a slightly higher chance of producing false positive results compared to the urea breath test.

Advantages of Stool Antigen Testing

  • Lower cost compared to urea breath test
  • Convenient for patients who may have difficulty with breath tests
  • Can be performed on young children

Despite its slightly lower specificity, the stool antigen test remains a valuable tool in H. pylori diagnosis, especially in situations where cost or patient factors make the urea breath test less feasible.

When to Consider H. pylori Testing

Determining when to test for H. pylori is crucial for effective diagnosis and treatment. Healthcare providers typically consider several factors when recommending H. pylori testing.

Common Indications for H. pylori Testing

  • Persistent dyspepsia symptoms
  • Unexplained abdominal pain
  • Family history of gastric cancer
  • Long-term use of NSAIDs
  • Unexplained iron deficiency anemia

In cases where patients present with “alarm” symptoms such as significant weight loss, persistent vomiting, or signs of gastrointestinal bleeding, more comprehensive evaluation methods, including endoscopy, may be necessary.

The Importance of Accurate H. pylori Diagnosis

Accurate diagnosis of H. pylori infection is crucial for several reasons. Why is precise detection so important? Firstly, it allows for targeted treatment, reducing unnecessary antibiotic use and potential side effects. Secondly, early detection and treatment can prevent the progression of H. pylori-related complications, such as gastric ulcers or even gastric cancer.

Benefits of Early H. pylori Detection and Treatment

  • Reduction of symptoms and improved quality of life
  • Prevention of ulcer development or recurrence
  • Decreased risk of gastric cancer in high-risk populations
  • Potential improvement in conditions associated with H. pylori, such as iron deficiency anemia

By utilizing accurate non-invasive testing methods like the urea breath test and stool antigen test, healthcare providers can effectively diagnose and monitor H. pylori infections, leading to better patient outcomes.

Future Directions in H. pylori Testing and Management

As our understanding of H. pylori and its impact on human health continues to evolve, so too do the methods for detecting and managing this infection. What advancements can we expect in H. pylori testing and treatment?

Emerging Technologies in H. pylori Detection

  • Point-of-care rapid tests for immediate results
  • Molecular testing methods for antibiotic resistance
  • Non-invasive imaging techniques for detecting H. pylori-related gastric changes

These emerging technologies hold promise for improving the speed, accuracy, and accessibility of H. pylori testing, potentially leading to more personalized and effective treatment strategies.

Challenges in H. pylori Management

Despite advancements in testing and treatment, H. pylori management faces several challenges. What are the main obstacles in effectively controlling H. pylori infections?

  • Increasing antibiotic resistance
  • Reinfection rates in high-prevalence areas
  • Variability in treatment response among different populations
  • Balancing the potential benefits and risks of eradication in asymptomatic individuals

Addressing these challenges will require ongoing research, development of new treatment strategies, and a comprehensive approach to H. pylori management that considers both individual patient factors and broader public health implications.

As we continue to refine our understanding of H. pylori and its impact on human health, the importance of accurate, accessible testing methods cannot be overstated. The urea breath test and stool antigen test represent significant advancements in non-invasive H. pylori detection, offering healthcare providers powerful tools for diagnosing and managing this common bacterial infection. By leveraging these testing methods and staying informed about emerging technologies and challenges, we can work towards more effective strategies for controlling H. pylori and reducing its impact on global health.

How To Do A Helicobacter Pylori Testing? |Gastro Health



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As previously discussed in our Fall 2012 issue, Helicobacter pylori (H. pylori) is a bacteria found in the stomach that can cause a variety of intestinal disorders such as peptic ulcers and gastritis. This bacterium is also a very common cause for dyspepsia, a syndrome consisting of epigastric discomfort, feelings of early fullness after eating, and bloating.

For patients who do not have “alarm” symptoms such as weight loss or vomiting which require a more thorough evaluation, non-invasive testing for H. pylori can easily and effectively diagnose the presence of this bacterium. One such test that is commonly available now is a urea breath test. This test can be used to both diagnose Helicobacter pylori and confirm its eradication. The test requires a patient to provide a sample of their breath about 20 minutes after ingesting a compound. This is based on the fact that H. pylori can covert a compound called urea to both carbon dioxide and ammonia.

During this test, a patient will ingest a detectable type of carbon called an isotope. If H. pylori is present, this isotope will incorporate into carbon dioxide and will then be detectable in the patient’s breath. There are two commercially available tests, and the only difference between these tests is the use of a radioactive isotope in one of the tests. It should be noted that the amount of radiation used in the test is essentially equal to the normal radiation a person is exposed in their daily life.

The urea breath test has a reported sensitivity and specificity of 95%, meaning the chance of a false positive test is very low. False negative tests can also occur, especially if a patient is being prescribed certain medications. The two classes of medications that can cause false negative results include antibiotics and proton pump inhibitors (PPIs) such as Nexium or Prilosec. These medications will suppress but not completely eliminate the presence of H. pylori in the stomach. In order to eliminate this risk, a patient must not use antibiotics for four weeks and PPIs for two weeks prior to undergoing the test.

Another option in terms of non-invasive evaluation is the use of an H. pylori stool antigen test. The antigen is essentially a marker for the presence of active bacteria. This test offers a similar accuracy as compared to urea breath testing in detecting the bacteria. However, it has a slightly higher chance of a false positive result in comparison to the urea breath test, and a similar chance of a false negative result. The main advantage of stool antigen testing is that it is slightly less costly as compared to the breath test.

The urea breath test is an increasingly common way for physicians to safely and accurately diagnose the presence of H. pylori in the most cost effective way possible. The increasing use of this test will undoubtedly lead to this bacterium to be more easily identified and thereby allow more and more patients to reap the benefits of treatment.


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Helicobacter Pylori

Somal S. Shah, MD


Gastroenterology
Internal Medicine


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Helicobacter Pylori (H. Pylori) is a bacteria found in the stomach. It was initially identified in 1982 when scientists discovered that this particular bacteria was present in patients suffering from chronic gastritis and gastric ulcers. Infection with H. Pylori can contribute to the development of gastritis (inflammation of the stomach), gastric or duodenal ulcers, and dyspepsia (upset stomach and or indigestion).


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Dyspepsia: When and How to Test for Helicobacter pylori Infection

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Helicobacter pylori, IgG (quantitative)

Detection of class G immunoglobulins (IgG) to Helicobacter pylori in blood serum, used to diagnose antral and fundal gastritis, gastric and duodenal ulcers, as well as to monitor their treatment.

Synonyms Russian

Helicobacter, class G immunoglobulins, IgG antibodies.

Synonyms English

Helicobacter pylori Antibody, IgG; Anti-Helicobacter pylori antibody, IgG (quantitative).

Research method *

Enzyme immunoassay.

* May vary by region.

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

Do not smoke for 30 minutes before the test.

General information about the study

H. pylori infection is accompanied by the development of a local and systemic immune response. Following a transient increase in the titer of class M immunoglobulins (IgM), a prolonged and significant increase in IgG-as well as IgA-antibodies in the blood serum follows. Determination of the concentration of immunoglobulins (serological examination) is used in the diagnosis of helicobacteriosis. IgG are found in 95-100% of cases of H. pylori infection, IgA – in 68-80%, and IgM – only in 15-20%. Therefore, to confirm infection with H. pylori, the concentration of IgG in the blood serum is determined. This analysis has a number of advantages over other laboratory methods for detecting Helicobacter pylori.

The determination of IgG in the blood does not require endoscopic examination, therefore it is a safer diagnostic method. Since the sensitivity of the test is comparable to that of most invasive tests (rapid urease test, histological examination), it is especially useful when endoscopy is not planned. However, it should be noted that the test does not directly detect the microorganism and depends on the characteristics of the patient’s immune response. So, for example, the immune response of the elderly is characterized by a reduced production of specific antibodies (any, including H. pylori), which must be taken into account if a negative test result is obtained with clinical signs of dyspepsia. In addition, the immune response is suppressed when taking certain cytotoxic drugs.

The IgG assay is most useful in diagnosing primary H. pylori infection (eg, in a young patient presenting with new onset of dyspepsia). In this situation, a high IgG titer suggests an active infection. Also, a positive test result in a patient (with or without a history of dyspepsia) who has not received therapy will indicate helicobacteriosis.

The interpretation of a positive test result if therapy has been performed (or if antibiotics with activity against H. pylori have been used for other purposes) has some peculiarities. The IgG level remains high for a long time after the complete death of the microorganism (about half of the patients cured of H. pylori will have high IgG titers for another 1-1.5 years). As a result, a positive test result in a patient treated with antibiotics does not allow differentiation between active infection and a history of infection and requires additional laboratory tests.

For the same reason, IgG testing is not the main test for diagnosing the effectiveness of therapy. However, it can be used for this purpose if the antibody titer at the onset of the disease is compared with the titer after the end of treatment. It is believed that a decrease in the concentration of IgG by 20-25% within 6 months indirectly indicates the death of the microorganism. At the same time, if this concentration does not decrease, this does not mean that the therapy is ineffective. The absence of IgG antibodies on re-analysis indicates the success of the treatment and getting rid of the microorganism.

The amount of IgG to H. pylori is also one of the components by which the state of the gastric mucosa is judged (this is the so-called serological biopsy).

What is research used for?

For diagnosing diseases caused by H. pylori and monitoring their treatment:

  • antral and fundic gastritis;
  • ulcers of the duodenum or stomach.

When is the examination scheduled?

  • When evaluating a patient with new onset of dyspepsia (primary H. pylori infection), especially if endoscopy is not planned.
  • When examining a patient with a history of dyspepsia, if H. pylori therapy was not prescribed (or if antibiotics active against H. pylori were not used for another reason).
  • During the primary diagnosis of helicobacteriosis and 6 months after the end of the course of its therapy.

What do the results mean?

Reference values: *

*Reference values ​​vary for some regions due to the use of different test systems for the study.

Reason for positive result

  • Active H. pylori infection:

a) a decrease in antibody titer by 20-25% within 6 months after the end of antibiotic therapy indirectly indicates the death of the microorganism;

b) the absence of a trend towards a decrease in IgG does not indicate the ineffectiveness of therapy.

  • history of H. pylori infection.

Reason for negative result:

  • no H. pylori infection;
  • death of a microorganism after a course of antibiotic therapy.

What can influence the result?

The immune response of the elderly, as well as patients receiving immunosuppressive therapy, is characterized by a reduced production of specific antibodies, including H. pylori, which leads to a greater number of false negative test reactions in this group of patients.

Important notes

  • A positive test result should be interpreted in the light of additional data (in particular, eradication therapy or use of antibiotics active against H. pylori for other purposes should be considered).

Also recommended

  • Helicobacter pylori DNA [real-time PCR]
  • Helicobacter pylori, IgA
  • Helicobacter pylori antigen
  • Gastrin
  • Pepsinogen I
  • Pepsinogen II
  • Antibodies to parietal cells of the stomach
  • Laboratory examination – gastritis and gastric ulcer
  • Laboratory diagnosis and monitoring of atrophic gastritis and peptic ulcer disease
  • Fecal occult blood test
  • Coprogram

Who orders the examination?

Gastroenterologist, pediatrician, general practitioner, infectious disease specialist.

Literature

  • Glupczynski Y. Microbiological and serological diagnostic tests for Helicobacter pylori: an overview. Br Med Bull. 1998;54(1):175-86.
  • Mark Feldman, MD; Byron Cryer, MD; Edward Lee, MD; Walter L. Peterson, MD. Role of Seroconversion in Confirming Cure of Helicobacter pylori Infection. JAMA. 1998;280(4):363-365. doi:10.1001/jama.280.4.363.
  • Athanasios Makristathis, Alexander M. Hirschl, Philippe Lehours, Francis Mégraud , . Diagnosis of Helicobacter pylori infection. Helicobacter. Volume 9, Issue Supplement s1, pages 7–14, August 2004.
  • Chernecky C. C. Laboratory Tests and Diagnostic Procedures / C.S. Chernecky, V.J. Berger; 5th ed. – Saunder Elsevier, 2008.

To know is to win. Diagnosis of Helicobacter pylori

Articles for patients
/ To know is to win. Diagnosis of Helicobacter pylori

9He licobacter р ylori transcription – X (G) elicoba kter pilo ́ ri – spiral gram-negative bacterium that infects various areas of the stomach dka and duodenum Many cases of gastric and duodenal ulcers, gastritis, duodenitis, cancer stomach and, possibly, some cases of gastric lymphomas are etiologically associated with infection Helicobacter pylori . However, the majority (up to 90%) of infected carriers of Helicobacter pylori do not show any symptoms of the disease.

The spiral shape of the bacterium, from which the generic name Helicobacter is derived, is believed to determine the ability of this microorganism to penetrate the mucous membrane of the stomach and duodenum and facilitate the movement of the bacterium in the mucous gel that covers the gastric mucosa.

The bacterium was rediscovered in 1979 by Australian pathologist Robin Warren, who then conducted further studies with Barry Marshall starting in 1981. Warren and Marshall were able to isolate and isolate this microorganism from samples of the human gastric mucosa. They were also the first to succeed in cultivating this microorganism on artificial nutrient media.

In 2005, the medical discoverers of the bacterium Robin Warren and Barry Marshall were awarded the Nobel Prize in Medicine.

There are several methods for determining H. pylori infection.

1. Non-invasive (not requiring endoscopy) tests for the presence of H. pylori infection:

– definition 9000 6 antibody titer in blood to antigens H . pylori . One step immunochromatographic method. May give false negative results due to low colonization of bacteria in the stomach, resulting in low concentrations of H. pylori antigens in faeces and failure to respond in the test. False-negative results may also be caused by uneven distribution of the antigen in the feces, destruction of the antigen by slowing down the evacuation of feces (constipation), gastrointestinal bleeding .

Detection of class G and A immunoglobulins to H. pylori in blood serum. May give false negative results in patients with a weak immune response, an early stage of infection. Diagnostic accuracy varies with duration of exposure to the bacterium, cross-antigenicity with other antigenically related bacteria, degree of gastritis, and contamination. In addition, antibodies persist for a long time after successful treatment, and it is difficult to use this method to check the success of the treatment. However, since H. pylori infection is chronic and its spontaneous clearance (complete and final self-healing only by the forces of the body) is impossible, positive antibody tests in untreated patients indicate the presence of an ongoing infection. Meanwhile, after successful treatment, the antibody titer decreases over time. The advantage of this method is that a blood test for antibodies can be done while taking antibiotics.

You can take these tests at any branch of the MBUZ CDC “Health”. Tests are taken from Monday to Friday, from 8.00-10.00, treatment room

– determination of the presence of antigens H 9 0006 . pylori kale . H. pylori detection, which uses real-time polymerase chain reaction (RT-PCR) to detect the genetic material (DNA) of a microorganism in a stool sample. The test is very sensitive to the quality of the test material, which can lead to false negative results, due to the fact that the test feces may contain substances that inhibit PCR: thermolabile proteins, glycolipids, DNA of other bacteria, complex polysaccharides (plant food residues), extracellular polysaccharides of other bacteria, blood, bile, excess inorganic salts, etc.

You can take this analysis at any branch of the MBUZ CDC “Health”. Analyzes are taken from Monday to Friday, from 8.