Caveats in Diagnosis of Helicobacter Pylori Infection can be Avoided by a Panel of Serum Biomarkers (GastroPanel®)

Abstract

Helicobacter pylori (HP) management (including diagnosis and therapy) has been exhaustively reviewed in several reports. These reports are unanimous in that several clinical conditions seriously hamper the diagnostic value of the two most com-monly used HP tests: 13 C-Urea Breath Test (UBT) and Stool Antigen test (SAT), both false-negative and false-positive results being not uncommon. Basically, these false-negative results are due to decreased bacterial loads in the stomach mucosa, and include the following clinical conditions: 1) use of PPI medication; 2) use of antibiotics; 3) bleeding peptic ulcer; 4) atrophic gastritis (AG; with or without intestinal metaplasia); 5) gastric cancer; 6) MALT lymphoma, and 7) partial gastrectomy. Since the late 1990's, it has been well established that UBT also gives false-positive results in cases where urease-producing bac-terial species are colonizing an acid-free stomach due to AG or a long term use of proton pump inhibitors (PPI). It is to be emphasized that neither UBT nor SAT (or HP serology) is capable of diagnosing AG, caused by HP infection or autoimmune disease, thus missing the patients at high risk for important clinical sequels of AG: I) gastric cancer (GC), ii) esophageal cancer, iii) vitamin-B12 deficiency (due to malabsorption), and iv) malabsorption of calcium, iron, magnesium and certain medicines. Conclusion: It is mandatory that these serious limitations (i.e., false-negative results in true disease, false-positives with no HP infection, and failure to diagnose AG) in use of UBT and SAT are properly acknowledged by all laboratories offering these two tests for diagnosis of HP infections. Given that this bacteria is the single most important risk factor of GC, it is time to move a step forward also in the diagnosis of Helicobacter pylori infections, and start using the test (GastroPanel®, Biohit Oyj, Finland) that is i) free from the shortcoming of the conventional HP tests, and ii) provides an added value by detecting also the other key risk factor of GC, i.e., atrophic gastritis.