Abstract
Background. Discrepancies between histology and serology results for Helicobacter pylori detection could be caused by a variety of factors, including a biopsy sampling error, expertise of the pathologist, natural loss of infection due to advanced atrophy, or a false-positive serology in the case of a previous infection, since antibodies may be present in blood following recovery from the infection. Aims. To identify true H. pylori-positive individuals in discrepant cases by serology and histology using real time polymerase chain reaction (RT-PCR) as a gold standard. Methods. Study subjects with discrepant histology and serology results were selected from the GISTAR pilot study data base in Latvia. Subjects having received previous H. pylori eradication therapy or reporting use of proton pump inhibitors, antibacterial medications, or bismuth containing drugs one month prior to upper endoscopy were excluded. We compared the discrepant cases to the corresponding results of RT-PCR performed on gastric biopsies. Results. In total, 97 individuals with discrepant results were identified: 81 subjects were serology-positive/histology-negative, while 16 were serology-negative/histology-positive. Among the serology-positive/histology-negative cases, 64/81 (79.0%) were false-positives by serology and, for the majority, inflammation was absent in all biopsies, while, in the serology-negative/histology-positive group, only 6.2% were proven false-positives by histology. Conclusions. Among this high H. pylori prevalent, middle-aged population, the majority of discrepant cases between serology and histology were due to false positive-serology, rather than false-negative histology. This confirms the available evidence that the choice of treatment should not be based solely on the serological results, but also after excluding previous, self-reported eradication therapy.
Highlights
The role of serology in Helicobacter pylori detection has been debated for decades
Advanced gastric atrophy and the total disappearance of H. pylori results in a false positive serology, since antibodies can be found for a prolonged period, making it impossible to distinguish active from past infection [5,6]
A standardized and quality-controlled approach to serology and pathology according to the GISTAR protocol allowed discrepancy issues to be addressed in a reliable way by selecting cases with different H. pylori statuses according to the serology and histology results from participants having undergone upper endoscopies
Summary
The role of serology in Helicobacter pylori detection has been debated for decades. Already, the Maastricht II recommendations have suggested to abandon the use of serology for clinical purposes and to limit its use to epidemiological studies only [1]. The most recent Maastricht V/Florence guidelines [2] limit the use of serology to specific cases, for example, in atrophy, considering that the bacterial load could be significantly decreased in severe gastric mucosal atrophy This was effectively demonstrated by Kokkola et al in a study where there were significantly decreased H. pylori antibody titers in individuals with atrophic gastritis with negative histology and 13C-urea breath test after prescribing an eradication treatment [3]. Among this high H. pylori prevalent, middle-aged population, the majority of discrepant cases between serology and histology were due to false positive-serology, rather than false-negative histology This confirms the available evidence that the choice of treatment should not be based solely on the serological results, and after excluding previous, self-reported eradication therapy
Published Version (Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have