Published online Nov 21, 2023. doi: 10.3748/wjg.v29.i43.5834
Peer-review started: August 19, 2023
First decision: September 28, 2023
Revised: October 10, 2023
Accepted: October 29, 2023
Article in press: October 29, 2023
Published online: November 21, 2023
There are differences in Helicobacter pylori (H. pylori) infection rate in Uyghur and Han ethnic groups. 14C urea breath test (14C UBT) and immunohistochemistry (IHC) with tissue from gastroscopic biopsy are widely used detection methods, but both lack large cohort studies to accurately evaluate their performance.
To compare the difference between 14C UBT and IHC for accurate testing for H. pylori infection, and to study the difference in infection positive rate between Uyghur and Han ethnic groups.
We included 5747 cases with H. pylori infection detected by both IHC and 14C UBT. We detected 3944 by simultaneous IHC and 14C UBT and 555 pairs of Han/Uyghur were compared for their H. pylori infection rate.
IHC and 14C UBT were performed at the same time (interval < 1 wk, with sampling site including gastric antrum), and 3944 cases were screened out. The overall H. pylori infection positive rate was calculated by combining IHC and 14C UBT results (n = 5747). Correlation between H. pylori infection and patients’ clinical parameters (gender, age, ethnicity and region) was analyzed. 555 pairs of Han/Uyghur cases (completely matched for gender and age) were compared for their H. pylori infection rates. The H. pylori infection rate and pathological diagnosis, including gastritis (chronic/active inflammation, atrophy, and intestinal metaplasia), were analyzed.
Among the 3944 cases for which 14C UBT and IHC were performed at the same time, the sensitivity was 94.9% for 14C UBT and 65.1% for IHC, which was a significant difference (P < 0.001). Among those positive by 14C UBT (detection value > 100), the H. pylori positive rate with IHC was 63.2%, and among those negative for 14C UBT (detection value ≤ 100), the IHC positive rate was 4.8%. In combination with both detection methods, the total rate of H. pylori infection in all 5747 patients was 48.6%, and there were significant differences for gender, age, ethnicity, and region (P values were 0.001, < 0.001, < 0.001 and < 0.001). The H. pylori infection rates for the 555 Chinese/Uyghur paired cases (completely matched for gender and age) were 41.4% and 73.3%, which was a significant difference (P < 0.001). For benign gastric lesions, the combined H. pylori infection rate was 53.8% for inflammation, 27.5% for fundus gland polyps, 22.2% for duodenal ectopic gastric mucosa, 17.5% for hyperplastic polyps, 58.7% for BE, and 67.6% for gastric adenocarcinoma. Positivity for H. pylori infection was significantly related to moderate-severe (grade 2-3) chronic inflammation, moderate-severe active inflammation and moderate-severe (grade 2-3) intestinal metaplasia (P < 0.001, < 0.001 and 0.032 in order).
The sensitivity of 14C UBT was significantly higher than that of IHC when detecting H. pylori infection, but there were still H. pylori positive cases missed that were detected by IHC. Combination of both methods can increase the detection accuracy of H. pylori infection, and the overall infection rate of H. pylori in our study was higher than previously reported in Xinjiang Uyghur Autonomous Region. Ethnic difference was the most important factor affecting the H. pylori infection rate, and the Uyghur people had more H. pylori infection. The H. pylori infection rate decreased with age, and was more correlated with precancerous lesions and malignant tumors, and increased with severity of inflammation.
Our study highlights the importance of using IHC and 14C UBT together for H. pylori infection, and the prevention and intervention of H. pylori infection in Xinjiang Uyghur Autonomous Region and emphasizes that the Uyghur and young people should be examined as early as possible.