Abstract
Background and objectives: Dyspepsia is a term used to describe upper abdominal pain or discomfort often associated with eating, early satiety, postprandial abdominal bloating or distention, and nausea. Many of these patients are infected with Helicobacter pylori. A simple method of diagnosis becomes imperative, to reduce the burden on endoscopy services. This study was aimed at determining the correlation between faecal antigen test and gastric mucosal histology in the diagnosis of Helicobacter pylori infection amongst patients undergoing upper gastrointestinal endoscopy.
Methods: A cross-sectional study of consecutive, consenting patients with dyspepsia presenting for upper gastrointestinal endoscopy. Fresh stool samples (rectal smears) were obtained from patients for Helicobacter pylori stool antigen test. Bio-data and results were recorded. Upper gastrointestinal endoscopy was performed using Pentax FG-29W gastroscope with a video monitor and detailed findings noted. Gastric biopsies (3 corpus and 3 antrum) were taken for histological diagnosis of Helicobacter pylori. Data were entered into SPSS (version 20) and analyzed using descriptive and inferential statistics.
Results: There were 150 patients comprising 61(40.7%) males and 89 (59.3%) females. The mean age (±SD) was 45.5 (±14.7) years with a range of 18 – 79 years. Helicobacter pylori was present in 93(62%) of patients on histology, and in 80 (53.3%) of them using Helicobacter pylori Stool Antigen Test (p = 0.000). The sensitivity, specificity, diagnostic accuracy, Positive predictive value, Negative predictive value and Area under the receiver operating characteristic curve for Helicobacter pylori stool antigen test were 79.6%, 89.5%, 83.3%, 92.5, 72.9% and 0.827 respectively. Positive and negative likelihood ratios were 7.58 and 0.228 respectively.
Conclusion: Helicobacter pylori stool antigen test compared favourably with histology and could possibly be used to complement the detection of H. pylori where Urea Breath Test and endoscopy are not available.
Keywords: Faecal antigen test, H. pylori, histology, gastric biopsy, correlation.
Résumé
Contexte et objectifs: La dyspepsie est un terme utilisé pour décrire les douleurs abdominales supérieures ou les inconvénients souvent associés à la consommation, la satiété précoce, les ballonnements abdominaux postprandial ou la distension et la nausée. Beaucoup de ces patients sont infectés par Helicobacter pylori. Une simple méthode de diagnostic devient impérative, afin de réduire le fardeau des services d’endoscopie. Cette étude visait à déterminer la corrélation entre le test de l’antigène fécal et l’histologie de la muqueuse gastrique dans le diagnostic de l’infection à Helicobacter pylori chez les patients soumis à une endoscopie gastro-intestinale supérieure.
Méthodes: étude transversale de patients consécutifs consentements à la dyspepsie présentant une endoscopie gastro-intestinale supérieure. Des échantillons de selles fraîches (frottis rectaux) ont été obtenus chez des patients pour un test d’antigène des selles Helicobacter pylori. Les données biologiques et les résultats ont été enregistrés. L’endoscopie gastro-intestinale supérieure a été effectuée en utilisant un gastroscope Pentax FG-29W avec un moniteur vidéo et des résultats détaillés constatés. Des biopsies gastriques (3 corpus et 3 antres) ont été prises pour le diagnostic histologique d’Helicobacter pylori. Les données ont été entrées dans SPSS (version 20) et analysées à l’aide de statistiques descriptives et par inférences.
Résultats: 150 patients comptant 61 (40,7%) hommes et 89 (59,3%) des femmes. L’âge moyen (± DE) était de 45,5 (± 14,7) ans avec une étendue de 18 à 79 ans. Helicobacter pylori était présent dans 93 (62%) des patients sur histologie et dans 80 (53,3%) d’entre eux faisant usage du Test Helicobacter pylori Stool Antigen (p = 0,000). La sensibilité, la spécificité, la précision diagnostique, la valeur prédictive positive, la valeur prédictive négative et la zone sous la courbe caractéristique de fonctionnement du récepteur pour le test antigénique des selles Helicobacter pylori étaient respectivement de 79,6%, 89,5%, 83,3%, 92,5, 72,9% et 0,827. Les rapports de vraisemblance positive et négative étaient respectivement de 7,58 et 0,228.
Conclusion: Le test d’antigène des selles de Helicobacter pylori a été comparé favorablement à l’histologie et pourrait éventuellement être utilisé pour compléter la détection de H. pylori où le test de respiration d’urée et l’endoscopie ne sont pas disponibles.
Mots-clés: Test d’antigène fécal, H. pylori, histologie, biopsie gastrique, corrélation.
Correspondence: Dr. B.I. Umoru, Department of Medicine, Federal Medical Centre, Lokoja, Kogi State, Nigeria. Email: benedictumoru@gmail.com
References
Tack J, Talley NJ, Camilleri M and Holtmann G. Functional gastroduodenal disorders. Gastroenterology 2006; 130:1466-1479.
Agreus L, Svardsudd K, Nyren O and Tibbin G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology 1995; 109:671-680.
American Gastroenterological Association. Technical review: Evaluation of dyspepsia. Gastroenterology 1998; 114:582-595.
Hameed L, Onyekwere CA and Otegbayo JA. A clinicopathological study of dyspeptic subjects in Lagos, Nigeria. Gastroenterology insights 2012; 4: 39-42.
Holcombe C, Omotara BA, Padonu MK and Bassi AP. The prevalence of symptoms of dyspepsia in North-Eastern Nigeria: A random community based survey. Trop Geogr Med 1991; 43: 209 - 214.
Kenneth R and McQuaid: Dyspepsia In: Feldman M, Friedman LS, Brandt LJ, Editors. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease; Pathophysiology, Diagnosis, Management. 2006; 1:122 – 124.
Cover T and Blaser M. Helicobacter pylori in health and disease. Gastroenterology 2009; 136: 1863-1873.
Smith SI, Oyedeji KS, Goodluck HA, et al. The use of Helicobacter pylori stool antigen test for the diagnosis of Helicobacter pylori in Lagos, Nigeria. West Indian Med. J., 2011; 60:33-35.
Aje AO, Otegbayo JA, Odaibo GN and Bojuwoye BJ. Comparative study of stool antigen test and serology for H pylori amongst Nigerian dyspeptic patients- a pilot study. Niger J Clin Prac, 2010; 13:120-124.
Oluwasola AO, Okolo CA, Otegbayo JA, et al. Comparative study of methods of diagnosis of Helicobacter pylori infection in Ibadan, Nigeria. Nig. J. Gastroenterol. Hepatol, 2011; 3:1-2.
Olufemi FO, Remi Q, Shittu OB, Bamiro SA, and Akinduti PA. Helicobacter pylori Stool Antigen in asymptomatic children in Lagos state, Nigeria. IJTDH 2015; 7: 156 - 162.
Laine L, Estrada R, Trujillo M, Knigge K and Fennerty MP. Effect of proton pump inhibitor therapy on diagnostic testing for Helicobacter pylori. Ann Intern Med.1997; 129: 547-550.
Dixon MF, Genta RM, Yardley JH and Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20:1161- 1181.
Michael Selgrad, Arne Kandulski, and Peter Malfertheiner. Helicobacter pylori: Diagnosis and Treatment. Curr Opin Gastroenterol. 2009; 25: 549-556.
Syam AF, Rani AA, Abdullah M, et al. Accuracy of Helicobacter pylori stool antigen for the detection of Helicobacter pylori infection in dyspeptic patients. World J Gastroenterol 2005; 11: 386-388.
Jemilohun AC, Otegbayo JA, Ola SO, Oluwasola OA and Akere A. Prevalence of helicobacter pylori among Nigerian patients with dyspepsia in Ibadan. Pan Afr Med J 2010; 6:18.
Ndububa DA, Agbakwuru AE, Adebayo RA, et al. Upper gastrointestinal findings and incidence of Helicobacter pylori infection among Nigerian patients with dyspepsia. West Afr J Med. 2001; 20:140-145.
Abo-Shadi MA, El-Shazly TA and Al-Johani MS. Clinical, Endoscopic, Pathological and Serological Findings of Helicobacter pylori Infection in Saudi Patients with Upper Gastrointestinal Diseases. Br J Med Med Res 2013; 3: 1109-1124.
Olokoba AB, Gashau W, Bwala S, Adamu A and Salawu FK. Helicobacter pylori infection in Nigerians with dyspepsia. Ghana Med J 2013; 47:79-81.
Mustapha S, Bolori M, Ajayi N, et al. Endoscopic Findings And The Frequency Of Helicobacter Pylori Among Dyspeptic Patients In North-Eastern Nigeria. Internet J Gastroenterol 2007; 6: 1-5.
Tijani B and Umar B. Peptic ulcer disease and helicobacter pylori infection at Kano, Nigeria. Internet J Gastroenterol. 2008; 8:1-5.
Bani-Hani KE and Hammori SM. Prevalence of Helicobacter pylori in Northern Jordan. Endoscopy-based study. Saudi Med J. 2001; 22:843-847.
Naji AS, A-Ameri GA, Alkadasi MN, et al. Comparison of stool antigen and blood antibody test methods for detection of Helicobacter pylori infection and the risk factors. Int. J. Curr. Microbiol. App. Sci. 2014; 3: 118- 127.
Falaknazi K, Jalalzadeh M and Vafaeimanesh J. Noninvasive Stool Antigen Assay for Screening of Helicobacter Pylori Infection and Assessing Success of Eradication Therapy in Patients on Hemodialysis. Iran J Kidney Dis 2010; 4: 317- 321.
Asfeldt AM, Lochen ML, Straume B, et al. Accuracy of a Monoclonal Antibody-based Stool Antigen Test in the Diagnosis of Helicobacter pylori Infection. Scand J Gastroenterol. 2004; 39:1073-1077.
Gisbert JP, de la Morena F and Abraira V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol 2006; 101:1921-1930.
Mohammed MO. Correlation of Endoscopic Findings with Various Helicobacter pylori Tests among Dyspeptic Patients. Int J Clin Med, 2014; 5: 1180-1188.
Youden WJ. Index for rating diagnostic tests. Cancer. 1950; 3: 32-35.
Kazemi S, Tavakkoli H, Habizadeh MR and Emami MH. Diagnostic values of Helicobacter pylori diagnostic tests: stool antigen test, urea breath test, rapid urease test, serology and histology. J Res Med Sci. 2011; 16: 1097 - 1104.
Farazi A, Molaienasab M, and Ghazisaeedi M. Diagnostic accuracy of a monoclonal antibody-based stool antigen test in Helicobacter pylori infectionin Iranian patients. World Appl. Sci. J., 2015; 33: 503-507.