Diagnosis of Helicobacter pylori Using Invasive and Noninvasive Approaches
Table 1
Overview of H. pylori diagnosis with invasive and noninvasive methods.
Name
Type
Reference method
Characteristics
Advantages
Disadvantages
UBT
Noninvasive
No
Sensitivity: >95% Specificity: >95%
(i) High specificity and sensitivity (ii) Useful to confirm H. P eradication (iii) Useful to detect gastroduodenal bleeding (iv) Relatively cheap, simple and safe (v) A gold standard only for asymptomatic patients (vi) No sampling errors, good for epidemiological studies (vii) practically useful for children ~100% sensitivity
(i) Rarely false positive results refer to urease positive organisms (ii) Radiation in the case of application of 14C-UBT (iii) No data about antibiotic resistance
Serology
Noninvasive
No
Sensitivity: >96% Specificity: 60–90%
(i) Has no false negative result (ii) Cheap, simple and safe (iii) Highly recommended for initial H. pylori screening (iv) Not affected by gastric bleeding (v) No false negative result in the case of PPI consumption (a unique character)
(i) No data about antibiotic resistance (ii) Failure in distinguish between active and past infection (iii) No application in clinical practice and hospitals
SAT
Noninvasive
No
Sensitivity: >95% Specificity: >95%
(i) High specificity and sensitivity (ii) Good popularity among patients (iii) Relatively fast and simple (iv) Easy modification to produce better results (v) No need to skilled staffs
(i) No data about antibiotic resistance (ii) The false positive result in the case of PPI and antibiotics (iii) Variation in specificity and sensitivity over the different clinical circumstances
Culture
Invasive
Yes
Sensitivity: 50–95% Specificity: >95%
(i) Existing the data about antibiotic resistance (ii) High specificity but low sensitivity (the most specific method existing) (iii) The possibility of having the pure bacterium and chance of preservation for a long time
(i) Need optimal incubation conditions and highly skilled operators (ii) Fast processes after endoscopy in necessary to avoid bacterial death (iii) Risk of the false negative result in the case of PPI and antibiotic consumption (iv) Need strict condition in transport before culturing (cool temperature) (v) Time-consuming and also the most expensive method
Histology
Invasive
Yes
Sensitivity: 60–90% Specificity: >95%
(i) The gold standard for direct H. pylori detection (ii) Almost cheap method for using in the universal scale (iii) Simple method
(i) Contradictory results following the PPI consumption (ii) Need extra biopsy sample and facing with ethical limitations (iii) Fluorescent microscope required method (limiting wide-spread usage) (iv) The relatively high rate of false negative reports
RUT
Invasive
No
Sensitivity: 95% Specificity: 80–90%
(i) Rapid, simple and cheap method (ii) High specificity (~99%), but low sensitivity (~80%) (iii) The most handful test in a clinical setting
(i) No data about antibiotic resistance (ii) Decreased sensitivity in patients with gastric bleeding (iii) Increased false negative results in the case of antibiotics & PPI consumption and achlorhydria (iv) Not useful for screening the eradication in epidemiologic studies
PCR
Invasive
No
Sensitivity: 80% Specificity: 100%
(i) Existing data about antibiotic resistance (ii) High specificity and sensitivity (iii) Tracking the mutations involved in antibiotic resistance (iv) The possibility of virulence typing (v) Useful to detect the bacterium in environmental samples (vi) Rapid and accurate results
(i) High cost (ii) Risk of contamination (iii) Time consuming and requirement to skilled staff (low feasibility in all laboratories) (iv) Lack of data about phenotypic antibiotic susceptibility profile
