Serology Is More Sensitive Than Urea Breath Test or Stool Antigen for the Initial Diagnosis of Helicobacter pylori Gastritis When Compared With Histopathology

Abstract Objectives To assess the concordance and performance characteristics of Helicobacter pylori laboratory tests compared with histopathology and to propose algorithms for the diagnosis of H pylori that minimize diagnostic error. Methods H pylori diagnostics were reviewed from a 12-year period...

Celý popis

Uloženo v:
Podrobná bibliografie
Vydáno v:American journal of clinical pathology Ročník 154; číslo 2; s. 255 - 265
Hlavní autoři: Bosch, Dustin E, Krumm, Niklas, Wener, Mark H, Yeh, Matthew M, Truong, Camtu D, Reddi, Deepti M, Liu, Yongjun, Swanson, Paul E, Schmidt, Rodney A, Bryan, Andrew
Médium: Journal Article
Jazyk:angličtina
Vydáno: US Oxford University Press 01.08.2020
Témata:
Algorithms
Antigens
Breath tests
Causes of
Comparative analysis
Diagnosis
Gastritis
Helicobacter infections
Helicobacter pylori
Histology, Pathological
Histopathology
Immunoglobulin G
Laboratories
Medical diagnosis
Serodiagnosis
Serology
Urea
United States
Testing algorithm
Histopathology
Utilization
Serology
Stool antigen
Diagnostic stewardship
Urea breath test
Gastritis
Helicobacter pylori
ISSN:0002-9173, 1943-7722, 1943-7722
On-line přístup:Získat plný text
Tagy: Přidat tag
Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!
Popis
Shrnutí:Abstract Objectives To assess the concordance and performance characteristics of Helicobacter pylori laboratory tests compared with histopathology and to propose algorithms for the diagnosis of H pylori that minimize diagnostic error. Methods H pylori diagnostics were reviewed from a 12-year period within a health system (2,560 cases). Analyses were performed to adjust diagnostic performance based on treatment and consensus histopathologic diagnoses among pathologists. Markers of access to care, including test cancellation frequency and turnaround time, were assessed. Costs and performance of candidate noninvasive testing algorithms were modeled as a function of disease prevalence. Results Serum H pylori IgG demonstrated a higher sensitivity (0.94) than urea breath and stool antigen tests (0.64 and 0.61, respectively). Evidence of an advantage in access to care for serology included a lower cancellation rate. Interobserver variability was higher (κ = 0.34) among pathologists for cases with a discordant laboratory test than concordant cases (κ = 0.56). A model testing algorithm utilizing serology for first-time diagnoses minimizes diagnostic error. Conclusions Although H pylori serology has modestly lower specificity than other noninvasive tests, the superior sensitivity and negative predictive value in our population support its use as a noninvasive test to rule out H pylori infection. Reflexive testing with positive serology followed by either stool antigen or urea breath test may optimize diagnostic accuracy in low-prevalence populations.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ISSN:0002-9173
1943-7722
1943-7722
DOI:10.1093/ajcp/aqaa043