Comparative Assessment of Current Serological Methods against the Conventional in the Diagnosis of Helicobacter pylori Infections in Suspected Peptic Ulcer Patients Attending Health Facilities in Lafia, Nigeria.

Abstract

Purpose: Helicobacter pylori has been implicated in most severe cases of peptic ulcer. Despite this development, the diagnosis of this infection has been a major challenge due to the difficulty encountered during isolation using the conventional culture method. Presently, most health facilities in rural communities in Nigeria still adopt the culture method as the gold standard technique for the diagnosis of H. pylori infections. The need for the introduction of more accurate, robust and rapid diagnostic techniques is therefore imperative. This study was carried out to compare the overall performance of two diagnostic methods in the assessment of Helicobacter pylori infection status among peptic ulcer suspected patients attending health facilities in Lafia, Nigeria, using stool antigen immunoassay test and blood antibody test methods.
 Methodology: A total of 180 patients with peptic ulcer symptoms attending three health facilities (80 from DASH and 50 each from Jafamek Diagnostic Centre and Haske Hospital) were recruited by designated health workers through random selection using non-probability and convenience sampling. The blood and stool samples of each participant were screened using H. pylori antibody/ antigen test strips (Azure Biotech Inc). The stool samples were cultured on Brain Heart Infusion agar (Oxoid, UK) and the result used as a gold standard in this study. Data obtained were presented as frequencies and association between test methods analysed using contingency chi-square test and Cohen kappa statistics.
 Results: The outcome of the study showed that out of the 180 participants screened, 51 (28.33%) were positive using the culture method (CM), 111 (61.67%) were reactive for Helicobacter pylori blood antibody test (BAB), while 86 (47.78%) were positive for Helicobacter pylori stool antigen test (SAG). The sensitivity and specificity of the two methods were recorded as 74.50%, 44.20% and 70.60%, 61.20% for BAB and SAG respectively. The level of agreement according to the value of kappa was found to be poor with BAB but fair with SAG.
 Conclusion: Based on the findings of this study, the overall prevalence of H. pylori infection among the patients was relatively low compared to values obtained from other areas in Nigeria. Also, the stool antigen analytical method had the highest diagnostic accuracy compared to the serum antibody and culture techniques.
 Recommendation: The stool antigen method is considered the most effective in the diagnosis of Helicobacter pylori infections in the study community and should therefore be used regularly as first choice option.