Does serology testing for H. pylori infections make sense for community-based physicians?

Abstract

We investigated whether the serological assessment of H. pylori (Hp) infections is an accurate diagnostic tool for general practitioners, which meaning Cag A and Vac A antibodies (AB) have in patients with ulcer disease (UD) or non ulcer dyspepsia (NUD), whether assessment of these mentioned AB can explain the highly significant ethnical differences regarding LID and whether there are other serological laboratory parameters correlating with Hp infections (e.g. BSR, RBC, WBC, CRP, electrophoresis, further Hp-specific ABs). Hp-status was assessed by endoscopy (urease-test, histology) and compared to serological parameters (Hp-CFR; Hp-immunoblot (Mikrogen) IgG / IgA; AB against CagA, VacA, Urease A + B and further Hp-specific antigens). 122 patients were investigated, n=86 were Hp-infected and untreated, n=36 were Hp-negative following successful eradication therapy with a new triplescheme (for six days: 500 mg azithromycin od + 2000 mg tinidazole od + 40 mg pantoprazole hid): 1) In 58 % of the successfully Hp-eradicated patients highly positive serological Hp-tests could be found even 1 18 months following triple-therapy; in 21% of all successfully treated patients therapy was 12 18 months ago. 2) In untreated patients together both AB against CagA + VacA tended to be positive more frequent in patients with UD (45.5% CagA + VacA positive) than with NUD (25.0% CagA + VacA positive). 3) The 3-fold higher ulcer rate in Turkish patients at 30.3 % of all Hp-infected patients with upper abdominal complaints could not be sufficiently clarified by means of serology (CagA+VacA together positive in 47.0% of Turkish versus 28.5% in European patients). 4) In 9% of all Hp-infected NUD and UD patients no CagA -, as well as no VacA AB Could be shown. 5) In 4% of all Hp-infected patients no CagA-AB could be found despite VacApositivity. 6) Neither in Hp-infected nor in successfully treated patients a correlation could be found regarding Hp-status and other serological above mentioned laboratory parameters. Also, the determination of Hp-CFR, of AB against urease A + B and further Hp-specific antigens had no meaning for the assessment of the inflammatory process and the severity of disease, Our data show, that Hp-serology testing is of low value for community based physicians, because serological results neither yield a certain evidence of the existence of an acute Hp-infection nor for the pathogenicity of H. pylori or the severity of the disease caused by these bacteria.