1. Review: Diagnosis of Helicobacter pylori infection
- Author
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Francis Mégraud, Athanasios Makristathis, Emilie Bessède, Alexander M. Hirschl, INSERM U1053, Université Bordeaux, Bordeaux, France., and Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
medicine.medical_specialty ,Urea breath test ,[SDV]Life Sciences [q-bio] ,Rapid urease test ,serology ,MESH: Molecular Diagnostic Techniques ,Gastroenterology ,Endoscopy, Gastrointestinal ,Helicobacter Infections ,Serology ,droplet digital PCR ,histology ,03 medical and health sciences ,13C urea breath test ,0302 clinical medicine ,Clarithromycin ,Internal medicine ,Humans ,Medicine ,stool antigen test ,Digital polymerase chain reaction ,MESH: Diagnostic Tests, Routine ,Immunoassay ,Breath test ,MESH: Humans ,medicine.diagnostic_test ,biology ,Diagnostic Tests, Routine ,business.industry ,MESH: Helicobacter Infections ,General Medicine ,Helicobacter pylori ,biology.organism_classification ,3. Good health ,MESH: Endoscopy, Gastrointestinal ,MESH: Breath Tests ,Infectious Diseases ,Breath Tests ,Molecular Diagnostic Techniques ,030220 oncology & carcinogenesis ,endoscopic imaging ,030211 gastroenterology & hepatology ,Gastritis ,medicine.symptom ,business ,real-time PCR ,MESH: Immunoassay ,medicine.drug - Abstract
International audience; Endoscopic imaging of the stomach is improving. In addition to narrow band imaging, other methods, for example, blue light imaging and linked color imaging, are now available and can be combined with artificial intelligence systems to obtain information on the gastric mucosa and detect early gastric cancer. Immunohistochemistry is only recommended as an ancillary stain in case of chronic active gastritis without Helicobacter pylori detection by standard staining, and recommendations to exclude false negative H. pylori results have been made. Molecular methods using real-time PCR, droplet digital PCR, or amplification refractory mutation system PCR have shown a high accuracy, both for detecting H. pylori and for clarithromycin susceptibility testing, and can now be used in clinical practice for targeted therapy. The most reliable non-invasive test remains the 13 C-urea breath test. Large data sets show that DOB values are higher in women and that the cut-off for positivity could be decreased to 2.74 DOB. Stool antigen tests using monoclonal antibodies are widely used and may be a good alternative to UBT, particularly in countries with a high prevalence of H. pylori infection. Attempts to improve serology by looking at specific immunodominant antigens to distinguish current and past infection have been made. The interest of Gastropanel® which also tests pepsinogen levels was confirmed.
- Published
- 2019