Stool Antigen Examination as a Diagnostic Tool for Dyspeptic Patient caused by Helicobacter pylori Infection: A Case-based Literature Review

Today, the gold standard for diagnosing H. pylori infection is by Urea Breath Test (UBT). However, UBT tests are not widely available in several remote areas in Indonesia. Stool antigen test (SAT) is an alternative diagnostic test for H. pylori infection. However, it is unclear whether the performance of the SAT to diagnose H. pylori infection can be comparable with UBT accuracy. This report was aimed to determine the accuracy of the stool antigen test (SAT) to diagnose H. pylori infection as an alternative to the urea breath test (UBT). Our case-based literature review indicates that the SAT has high sensitivity (79%-96.4%). Therefore stool antigen tests can help doctors in ruling out H. pylori infection. SAT also demonstrates remarkable specificity of stool antigen examination (98.6%-100%), suggesting that stool antigen tests can help doctors rule in H. pylori infection.

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The Use of 13C-Urea Breath Test for Non-Invasive Diagnosis of Helicobacter pylori Infection in Comparison to Endoscopy and Stool Antigen Test

Diagnostics ◽

10.3390/diagnostics10070448 ◽

2020 ◽

Vol 10 (7) ◽

pp. 448

Author(s):

Hamed Alzoubi ◽

Asma’a Al-Mnayyis ◽

Ibrahim Al rfoa ◽

Amin Aqel ◽

Mohammad Abu-Lubad ◽

...

Keyword(s):

Breath Test ◽

Eradication Therapy ◽

Urea Breath Test ◽

P Value ◽

Antigen Test ◽

Stool Antigen Test ◽

Non Invasive ◽

Stool Antigen ◽

13C Urea Breath Test ◽

H Pylori

Helicobacter pylori (H. pylori) can cause gastritis, peptic ulcer diseases and gastric carcinoma. Endoscopy as the gold standard method of diagnosis is an invasive procedure that might not be suitable in all scenarios. Therefore, this first study in Jordan aimed to assess the non-invasive 13C urea breath test (UBT) and stool antigen test for diagnosis of H. pylori infection and the successfulness of eradication therapy as alternatives for endoscopy. Hence, a total of 30 patients attending the endoscopy units at Alkarak teaching hospital were asked to complete a questionnaire with demographic and clinical data. They were then tested for H. pylori using 13C UBT and H. pylori stool antigen before having endoscopy. Another 30 patients who were positive for H. pylori by endoscopy were tested using both tests 6 weeks post eradication therapy. Results showed that the rate of H. pylori detection using endoscopy was 56.7% (17/30). Heartburns (82.3%, p value = 0.019), epigastric pain (88.2%, p value = 0.007) and vomiting (70.5%, p value = 0.02) were the most significant symptoms. Family history of peptic ulcer diseases was significantly associated with an increased risk for having a H. pylori positive result (p value = 0.02). Compared to endoscopy, the sensitivity of 13C UBT for the diagnosis of H. pylori was 94.1% (16/17), while it was 76.5% (13/17) for the stool antigen test. The specificity of both tests was equal (76.9%). However, the positive predictive and negative predictive values (84.2% and 90.9%) for 13C UBT were higher than those (81.3% and 71.4%) for the stool antigen test. The accuracy of 13C UBT was 86.7% compared to 76.7% for the stool antigen test. There was an 87% agreement (20 patients out of 23) between both tests when used to assess success of the eradication therapy. In conclusion, the 13C UBT was found to be more sensitive and accurate than the stool antigen test when used for diagnosis; furthermore, it has a comparable outcome to the stool antigen test in assessing the successfulness of the eradication treatment.

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