Identificación de las pruebas más sensibles y específicas para el diagnóstico de Helicobacter pylori pre y post-tratamiento en pacientes dispépticos
Identification of the most sensitive and specific tests for the diagnosis of Helicobacter pylori pre and post-treatment dyspeptic patients
DOI:
https://doi.org/10.54495/Rev.Cientifica.v25i2.89Keywords:
fecal antigen, serology, dyspepsia, pepsinogenAbstract
With the objective to determine a non-invasive most sensible and specific test for the diagnosis of H. pylori infection and confirming eradication after treatment, 178 patients with dyspepsia were prospectively studied during treatment at the Endoscopy clinic of the National Cancer Institute (INCAN).
They underwent fecal antigen detection using a commercial immunoassay (Anarapid ®) technique and a panel of serological tests that included IgM, IgA, IgG (CagA) anti-H. pylori by immunosorbent assay (ELISA). These tests were statistically evaluated through 2x2 contingency
tables (Kappa index) comparing with the biopsy results, which is considered the gold standard. Likewise enzyme assays were performed (Pepsinogen I and II) to assess the integrity of the gastric mucosa and determined its correlation with symptoms according to chi-square test.
Findings indicate that the detection of IgA anti-H. pylori had the highest sensitivity (74.2%) and the fecal antigen test had the highest specificity (69.9%) compared to the other tests. Sixty three patients diagnosed with initial stage H. pylori infection received specific treatment and were followed for 5 months to evaluate changes. At the end of five months of specific treatment, the same test panel was gathered.
Results showed that in most patients values pepsinogen I and II were within normal range. In post-treatment evaluation the rate of pepsinogen I / II was normalized in 24.86% of patients and the number of asymptomatic patients increased from 1.1% to 30.99%, which demonstrated the efficacy of treatment.
Results show that fecal antigen and IgA antibody against H. pylori tests are together the recommended tests for diagnosis of pre-treatment infection, whereas in the post-treatment phase, the fecal antigen test demonstrated therapeutic success. Values of pepsinogen I and II were in the normal range for the majority of the study population, which is indicative of suffering from functional dyspepsia or another disease that affects the gastric mucosa. It is further necessary to continue studies of the usefulness of the determination of pepsinogen I / II and its association with the risk of developing gastric cancer.
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Copyright (c) 2015 V. Matta de García, K.J. Lange, N.I. Hornquist, M.J. Camó, M.A. Benito, E.A. Maldonado, J.H. Gómez, A. Zetina, F. Nave, K.M. Guerrero
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