|Year : 2016 | Volume
| Issue : 1 | Page : 66-68
|Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients
Rumpa Saha1, Priyamvada Roy1, Shukla Das1, Navneet Kaur2, Ankita Kumari1, Iqbal Rajinder Kaur1
1 Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
2 Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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|Date of Web Publication||9-Mar-2016|
| Abstract|| |
Helicobacter pylori (HP) is causally associated with peptic ulcer disease and gastric carcinoma. Determination of the prevalence of HP infection in dyspepsia patients' in particular geographical area is imperative for the appropriate management of dyspepsia. HP antigen detection in stool is a noninvasive diagnostic test of HP infection. This prospective study was conducted to find out the prevalence of HP infection based on stool antigen testing in dyspeptic patients who had also undergone upper gastrointestinal (GI) endoscopy. This study highlights the high prevalence of HP infection in dyspeptic Indian patients, particularly males, and emphasizes the growing importance of the bacterium causing infection among children. We also found HP stool antigen testing to be superior to upper GI endoscopy for detecting HP infection. Hence, we recommend initial testing for HP stool antigen in dyspeptic patients before initiating treatment and before carrying out any invasive procedure such as endoscopy.
Keywords: Dyspepsia, endoscopy, Helicobacter pylori, stool antigen test
|How to cite this article:|
Saha R, Roy P, Das S, Kaur N, Kumari A, Kaur IR. Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients. Indian J Pathol Microbiol 2016;59:66-8
|How to cite this URL:|
Saha R, Roy P, Das S, Kaur N, Kumari A, Kaur IR. Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients. Indian J Pathol Microbiol [serial online] 2016 [cited 2020 Sep 26];59:66-8. Available from: http://www.ijpmonline.org/text.asp?2016/59/1/66/174819
| Introduction|| |
Helicobacter pylori (HP) is a significant cause of chronic active gastritis, duodenal ulcer, gastric ulcer, primary gastric B-cell lymphoma or mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. HP has been classified as group I carcinogen for gastric carcinoma by the World Health Organization and an HP-infected individual has 2-8 times higher risk of gastric carcinoma than the general population.  Owing to its momentous pathologic role in various diseases, the diagnosis of HP infection remains a subject of interest.
Determination of the prevalence of HP infection in dyspepsia patients holds an important place in the initial management of dyspepsia. The National Institute for Clinical Excellence recommends initial management with full-dose proton-pump inhibitor (PPI) for 1-month for dyspeptic patients of any age but without alarm symptoms. If they relapse, they should be tested for HP, and expensive but more accurate noninvasive breath and stool antigen tests should be used instead of blood serology.  The American Gastroenterological Association recommends HP "test and treat" policy as the initial management strategy of choice for uncomplicated dyspepsia, provided the prevalence of infection is >10%.  At 5-10% prevalence, the optimum strategy is uncertain; at <5%, test and treat is unlikely to be of much benefit, and empirical PPI therapy is recommended as the initial approach. 
HP antigen detection in stool is a rapid, noninvasive, easy to perform test that can be used to detect active infection, monitor effectiveness during therapy, and to confirm cure after antibiotic use. ,, Hence, we conducted a prospective study in the Department of Microbiology of a Tertiary Care Hospital in East Delhi to determine the burden of HP infection in dyspepsia patients using HP stool antigen test.
| Materials and methods|| |
Fifty patients of dyspepsia were recruited in the study after undergoing upper gastrointestinal (GI) tract endoscopy (June-October 2014). Institutional ethical clearance was obtained for this study. Written informed consent was obtained from all participants. Dyspepsia was defined as per Rome III diagnostic criteria, as the presence of one or more dyspepsia symptoms (postprandial fullness, early satiation, epigastric pain, and epigastric burning) that are considered to originate from the gastroduodenal region, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Patients were excluded if they had any of the following: A family history or symptoms suggestive of gastric cancer; GI bleeding; lymphadenopathy; and jaundice: Or those who had received antibiotics, PPIs, or antacids in the previous 4 weeks. Stool samples were collected from the patients who were satisfying the above criteria. A quantitative ELISA for HP antigen (HP antigen ELISA, Diagnostic Bioprobes, Italy) was performed on the stool samples as per the manufacturer's instructions. Samples showing a concentration of HP antigen higher than 0.05 μg/ml were considered as positive.
Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 13.0 (SPSS Inc., Chicago, USA). P value was calculated using Chi-square test. Statistical significance was defined as P < 0.05.
| Results|| |
Out of the 50 samples tested, 30 (60%) were positive for HP antigen. Fifteen of the 30 positive samples were positive for gastroduodenal ulceration and erosive antral gastritis suggestive of HP infection on endoscopy. Rest of the HP antigen-positive samples and all HP antigen negative samples were negative for the features suggestive of HP infection on endoscopy. Though most of the study subjects were females (30 females vs. 20 males), HP antigen detection was 3 times more frequent in males than in females (30% in males vs. 10% in females). However, the difference was not statistically significant (P - 0.06). Maximum positivity was in the age-group of 0-20 years [Table 1], which was statistically significant (P - 0.0004). The concentration of HP antigen correlated with the severity of dyspeptic symptoms in our patients. The highest concentration of HP antigen was detected in an 18-year-old male with 2 years of dyspepsia (0.3532 μg/ml).
| Discussion|| |
Sixty percent of the samples were positive for HP antigen. This is higher than the cut-off recommended for "test and treat" policy.  Low socioeconomic status, overcrowding, and unhygienic conditions contribute to the high prevalence of HP infection in the developing countries including India.  The cases which were HP antigen-positive but endoscopy-negative may be the early cases of dyspepsia due to HP infection. HP antigen detection was found to be more frequent in males than in females. An excess of HP prevalence in males versus females has been reported in other studies as well; for instance, Woodward et al. and Gowda et al. observed a higher prevalence of HP in men than in women. ,, A comprehensive meta-analysis of large, population-based studies concluded a male predominance of HP-related diseases. ,
In the present study, maximum positivity was in the age-group of 0-20 years, which was also statistically significant. Similar findings have been reported in various studies. ,,, Studies from Hyderabad and Mumbai have shown that by 10 years of age, more than 50% and by 20 years of age, more than 80% of the population is infected with HP. , A study from Delhi in 258 patients admitted for nongastroenterological diseases found the seroprevalence of 52% by 20 years of age and peak prevalence of 68% at 30-39 years of age.  Hestvik et al. have also reported the overall prevalence of 44.3% in a study conducted in Uganda involving HP antigen detection in children up to 12 years of age.  In most of the cases, infection is acquired in the first decade of life. Children seem to acquire infection mainly through feco-oral route since HP has been isolated from the stool of infected children, and oral-oral route (by kissing and feeding of premasticated food) has also been reported. 
| Conclusion|| |
The current study demonstrated a high prevalence of HP antigen in dyspepsia patients in this geographical region. Since the level of HP antigen positivity in our study correlated with the severity of dyspepsia symptoms, we recommend an initial testing for HP in dyspeptic patients by a simple noninvasive method of stool HP antigen testing before any treatment is initiated and before endoscopy is done. We also advocate greater alertness to detect HP in children and males, since they have been found to have a higher prevalence of HP antigen.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Poddar U, Yachha SK. Helicobacter pylori
in children: An Indian perspective. Indian Pediatr 2007;44:761-70.
National Institute for Health and Clinical Excellence, National Guideline Research and Development Unit. Dyspepsia: Managing Dyspepsia in Adults in Primary Care. NICE; 2004. Available from: http://www.nice.org.uk/nicemedia/pdf/CG017fullguideline.pdf. [Last accessed on 2014 Nov 10].
Talley NJ, Vakil NB, Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology 2005;129:1756-80.
Martin JJ, Anbumani N, Kalyani M, Rajesh PK. H. pylori
antigen detection in stool. Indian J Med Microbiol 2006;24:79-80.
Konstantopoulos N, Rüssmann H, Tasch C, Sauerwald T, Demmelmair H, Autenrieth I, et al.
Evaluation of the Helicobacter pylori
stool antigen test (HpSA) for detection of Helicobacter pylori
infection in children. Am J Gastroenterol 2001;96:677-83.
Syam AF, Rani AA, Abdullah M, Manan C, Makmun D, Simadibrata M, et al.
Accuracy of Helicobacter pylori
stool antigen for the detection of Helicobacter pylori
infection in dyspeptic patients. World J Gastroenterol 2005;11:386-8.
Woodward M, Morrison C, McColl K. An investigation into factors associated with Helicobacter pylori
infection. J Clin Epidemiol 2000;53:175-81.
Gowda KL, Marie MA, John J, Pradeep CS, Dabwan KH, Sangeetha G. Cytopathic effects of toxogenic strains of Helicobacter pylori
on different cell lines. Indian J Pathol Microbiol 2014;57:187-90.
Khalifa MM, Sharaf RR, Aziz RK. Helicobacter pylori
: A poor man's gut pathogen? Gut Pathog 2010;2:2.
de Martel C, Parsonnet J. Helicobacter pylori
infection and gender: A meta-analysis of population-based prevalence surveys. Dig Dis Sci 2006;51:2292-301.
Graham DY, Adam E, Reddy GT, Agarwal JP, Agarwal R, Evans DJ Jr, et al.
Seroepidemiology of Helicobacter pylori
infection in India. Comparison of developing and developed countries. Dig Dis Sci 1991;36:1084-8.
Gill HH, Majmudar P, Shankaran K, Desai HG. Age-related prevalence of Helicobacter pylori
antibodies in Indian subjects. Indian J Gastroenterol 1994;13:92-4.
Jais M, Barua S. Seroprevalence of anti Helicobacter pylori
IgG/IgA in asymptomatic population from Delhi. J Commun Dis 2004;36:132-5.
Hestvik E, Tylleskar T, Kaddu-Mulindwa DH, Ndeezi G, Grahnquist L, Olafsdottir E, et al. Helicobacter pylori
in apparently healthy children aged 0-12 years in urban Kampala, Uganda: A community-based cross sectional survey. BMC Gastroenterol 2010;10:62.
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