Brief Article
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World J Gastroenterol. Nov 14, 2011; 17(42): 4682-4688
Published online Nov 14, 2011. doi: 10.3748/wjg.v17.i42.4682
Diagnostic accuracy of tests for Helicobacter pylori in an Alaska Native population
Dana L Bruden, Michael G Bruce, Karen M Miernyk, Julie Morris, Debby Hurlburt, Thomas W Hennessy, Helen Peters, Frank Sacco, Alan J Parkinson, Brian J McMahon
Dana L Bruden, Michael G Bruce, Karen M Miernyk, Julie Morris, Debby Hurlburt, Thomas W Hennessy, Helen Peters, Alan J Parkinson, Brian J McMahon, Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging Zoonoses and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, United States
Karen M Miernyk, Frank Sacco, Brian J McMahon, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, United States
Author contributions: McMahon BJ, Parkinson AJ and Sacco F designed this research study; Hurlburt D and Peters H collected the data; Morris J and Miernyk KM conducted the laboratory testing; Bruden DL analyzed the data; Bruden DL, Bruce MG, Miernyk KM and Morris J wrote the paper; Hennessy TW and McMahon BJ provided critical review of the paper.
Supported by The Centers for Disease Control and Prevention; 13C urea breath tests were provided by Meretek Diagnostics Inc., Lafayette, CO, United States
Correspondence to: Dr. Dana L Bruden, MS, Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging Zoonoses and Infectious Diseases, Centers for Disease Control and Prevention, 4055 Tudor Centre, Anchorage, AK 99508, United States. dbruden@cdc.gov
Telephone: +1-907-729-3431 Fax: +1-907-729-3429
Received: November 3, 2010
Revised: December 1, 2010
Accepted: December 8, 2010
Published online: November 14, 2011
Abstract

AIM: To evaluate the accuracy of two non-invasive tests in a population of Alaska Native persons. High rates of Helicobacter pylori (H. pylori) infection, H. pylori treatment failure, and gastric cancer in this population necessitate documentation of infection status at multiple time points over a patient’s life.

METHODS: In 280 patients undergoing endoscopy, H. pylori was diagnosed by culture, histology, rapid urease test, 13C urea breath test (UBT), and immunoglobulin G antibodies to H. pylori in serum. The performances of 13C-UBT and antibody test were compared to a gold standard defined by a positive H. pylori test by culture or, in case of a negative culture result, by positive histology and a positive rapid urease test.

RESULTS: The sensitivity and specificity of the 13C-UBT were 93% and 88%, respectively, relative to the gold standard. The antibody test had an equivalent sensitivity of 93% with a reduced specificity of 68%. The false positive results for the antibody test were associated with previous treatment for an H. pylori infection [relative risk (RR) = 2.8]. High levels of antibodies to H. pylori were associated with chronic gastritis and male gender, while high scores in the 13C-UBT test were associated with older age and with the H. pylori bacteria load on histological examination (RR = 4.4).

CONCLUSION: The 13C-UBT outperformed the antibody test for H. pylori and could be used when a non-invasive test is clinically necessary to document treatment outcome or when monitoring for reinfection.

Keywords: Urea breath test; Antibody test; Sensitivity; Specificity