Evaluation of endoscopy based H. pylori diagnostic techniques in Iraqi patients with upper gastrointestinal disorders

Abstract

Objectives: The aim is to detxermine the accuracy and degree of agreement of invasive methods. Methods: Gastroduodenal biopsies examined by Homemade Rapid Urease Test (HM-RUT), culture, Gram staining, Hematoxylin and Eosin staining (H & E) and insitu hybridization (ISH). Results: A total of (106) patients with mean age (44.70) years, male to female ratio was 1.25/1. H. pylori associated disorders diagnosed in (33-41), (69-77) and (24-32) years, mainly gastritis(37.7%), gastropathy (27.4%), gastric ulcer (15.1%), duodenal ulcer (12.3%), duodenitis (5.66%) and Pre pyloric ulcer (1.89%). Positivity of tests were HM-RUT (82.08%), HE (61.32%), Gram stain (60.4%), culture (21.7%) CagA-ISH (45.28%). Accuracy measures were HM-RUT, H & E staining, Gram staining, CagA-ISH and Culture respectively. Good agreement (82.08%) was recorded between H & E and Gram stain. Moderate agreement (79.25%, 78.30%) between HM-RUT, H & E and Gram stain respectively. Fair agreement (55.66%) between H & E and culture, Gram stain and culture, Gram stain and Cag A-ISH, Culture and Cag A-ISH (61.32%, 59.43%, and 68.87%) respectively. Poor agreement between HM-RUT - culture and CagA-ISH, H & E and Cag A-ISH (39.62%, 55.66% and 55.66%) respectively. Conclusions: HM-RUT was the most accurate and can be used as gold standard alternative for H & E and Gram stain for H. pylori diagnosis. Culture alone cannot be used as gold standard due to sensitivity, diagnostic accuracy, agreement with other tests was low. Cag A-ISH is not favora-ble for routine diagnosis but for tissue localization of H. pylori Cag A.