The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Various Diagnostic Methods for Helicobacter pylori Infection

헬리코박터 파일로리 감염의 다양한 진단법

  • Han Jo Jeon (Division of Gastroenterology & Hepatology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Hyuk Soon Choi (Division of Gastroenterology & Hepatology, Department of Internal Medicine, Korea University College of Medicine)
  • 전한조 (고려대학교 의과대학 내과학교실 소화기내과) ;
  • 최혁순 (고려대학교 의과대학 내과학교실 소화기내과)
  • Received : 2024.02.29
  • Accepted : 2024.04.01
  • Published : 2024.04.01
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Abstract

Helicobacter pylori (H. pylori) is a bacterium that colonizes the human stomach, leading to various gastrointestinal diseases including gastritis, peptic ulcers, and gastric cancer. There is no gold standard test that relies entirely on one method in H. pylori diagnosis. We must be aware of the pros and cons of various testing methods to perform an appropriate test according to the situation. Accurate diagnosis and eradication therapy are essential for disease management. Diagnostic methods include invasive techniques like tissue biopsy and rapid urease test, as well as non-invasive tests such as urea breath test, serology test, and stool antigen test. Each method has its advantages and limitations, requiring careful consideration in clinical practice. Understanding these diagnostic tools is crucial for effective H. pylori management and prevention of associated complications.

H. pylori는 위장 점막에 집락화하여 만성 위염, 장상피화생, 위궤양, 위암 등의 질환을 유발한다. H. pylori 감염의 진단은 위장 조직 여부에 따라 침습적 방법과 비침습적 방법으로 나뉜다. 비침습적 방법에는 요소호기 검사가 있으며 민감도, 특이도가 높지만 내성 균주를 알 수 없는 한계가 있다. 혈청 검사는 특이도가 높아 일차 검사로 적합하지만 민감도가 낮고 현성 감염을 구분하지 못해 해석에 주의가 필요하다. 소변 및 대변 검사는 가격이 저렴하고 단순하지만 민감도가 낮고 검사의 정확도가 검체 상태에 영향을 받는다. 조직 검사는 특이도가 높고, 항생제 내성에 관한 정보를 배양 및 분자 검사를 통해 얻을 수 있지만 침습적이며 조직 채취오류에 따른 위음성 가능성이 있다. 급속 요소분해효소 검사는 일차 검사로 적합하지만 검체 양과 기질에 따라 분석 시간 및 정확도가 달라질 수 있다. 배양 검사는 배양의 어려움 때문에 일차 검사로 적합하지 않다. PCR 검사는 H. pylori 내성 및 변이 유무를 확인하여 개인별 맞춤 치료를 가능하게 하지만 가격이 비싸고 고도의 전문성이 요구된다. 따라서 다양한 검사법을 잘 숙지하고 적용하는 것이 H. pylori 감염 진단과 치료에 가장 중요하다.

Keywords

References

  1. Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 2017;153:420-429. https://doi.org/10.1053/j.gastro.2017.04.022
  2. Jung HK, Kang SJ, Lee YC, et al. Evidence-based guidelines for the treatment of Helicobacter pylori infection in Korea: 2020 revised edition. Korean J Helicobacter Up Gastrointest Res 2020;20:261-287.  https://doi.org/10.7704/kjhugr.2020.0045
  3. O'Connor A, O'Morain CA, Ford AC. Population screening and treatment of Helicobacter pylori infection. Nat Rev Gastroenterol Hepatol 2017;14:230-240.  https://doi.org/10.1038/nrgastro.2016.195
  4. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence consensus report. Gut 2017;66:6-30.  https://doi.org/10.1136/gutjnl-2016-312288
  5. Gisbert JP, Olivares D, Jimenez I, Pajares JM. Long-term follow-up of 13C-urea breath test results after Helicobacter pylori eradication: frequency and significance of borderline delta13CO2 values. Aliment Pharmacol Ther 2006;23:275-280.  https://doi.org/10.1111/j.1365-2036.2006.02741.x
  6. Gisbert JP, Pajares JM. Review article: 13C-urea breath test in the diagnosis of Helicobacter pylori infection -- a critical review. Aliment Pharmacol Ther 2004;20:1001-1017.  https://doi.org/10.1111/j.1365-2036.2004.02203.x
  7. Kwon YH, Kim N, Lee JY, et al. The diagnostic validity of the (13)C-urea breath test in the gastrectomized patients: single tertiary center retrospective cohort study. J Cancer Prev 2014;19:309-317.  https://doi.org/10.15430/JCP.2014.19.4.309
  8. Aumpan N, Mahachai V, Vilaichone RK. Management of Helicobacter pylori infection. JGH Open 2022;7:3-15.  https://doi.org/10.1002/jgh3.12843
  9. Gisbert JP, de la Morena F, Abraira V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol 2006;101:1921-1930.  https://doi.org/10.1111/j.1572-0241.2006.00668.x
  10. Husson MO, Rolland C, Gottrand F, et al. Evaluation of a Helicobacter pylori stool antigen test for the diagnosis and follow-up of infections in children. Eur J Clin Microbiol Infect Dis 2000;19:787-789.  https://doi.org/10.1007/s100960000371
  11. Miwa H, Hirose M, Kikuchi S, et al. How useful is the detection kit for antibody to Helicobacter pylori in urine (URINELISA) in clinical practice? Am J Gastroenterol 1999;94:3460-3463.  https://doi.org/10.1111/j.1572-0241.1999.01608.x
  12. Kato M, Asaka M, Saito M, et al. Clinical usefulness of urine-based enzyme-linked immunosorbent assay for detection of antibody to Helicobacter pylori: a collaborative study in nine medical institutions in Japan. Helicobacter 2000;5:109-119.  https://doi.org/10.1046/j.1523-5378.2000.00017.x
  13. Leodolter A, Vaira D, Bazzoli F, et al. European multicentre validation trial of two new non-invasive tests for the detection of Helicobacter pylori antibodies: urine-based ELISA and rapid urine test. Aliment Pharmacol Ther 2003;18:927-931.  https://doi.org/10.1046/j.1365-2036.2003.01761.x
  14. Lee YH, Lee SY, Kim YT, et al. Diagnosis of Helicobacter pylori infection with urine and stool. Korean J Gastroenterol 2003;42:115-120. 
  15. Opekun AR, Luu P, Gotschall AB, et al. Point-of-care Helicobacter pylori urine antibody detection in a multi-ethnic adult population in the United States. Transl Res 2006;148:13-18.  https://doi.org/10.1016/j.lab.2006.03.008
  16. Lee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med 2015;3:10. 
  17. Choi YI, Chung JW. Helicobacter pylori eradication in patients undergoing gastrectomy: diagnosis and therapy. Korean J Helicobacter Up Gastrointest Res 2020;20:204-209.  https://doi.org/10.7704/kjhugr.2019.0037
  18. Wang YK, Kuo FC, Liu CJ, et al. Diagnosis of Helicobacter pylori infection: current options and developments. World J Gastroenterol 2015;21:11221-11235.  https://doi.org/10.3748/wjg.v21.i40.11221
  19. Lee HJ, Kim JI, Cheung DY, et al. Eradication of Helicobacter pylori according to 23S ribosomal RNA point mutations associated with clarithromycin resistance. J Infect Dis 2013;208:1123-1130.  https://doi.org/10.1093/infdis/jit287
  20. Nezami BG, Jani M, Alouani D, Rhoads DD, Sadri N. Helicobacter pylori mutations detected by next-generation sequencing in formalin-fixed, paraffin-embedded gastric biopsy specimens are associated with treatment failure. J Clin Microbiol 2019;57:e01834-18. 
  21. Szymczak A, Ferenc S, Majewska J, et al. Application of 16S rRNA gene sequencing in Helicobacter pylori detection. PeerJ 2020;8:e9099. 
  22. Fontenete S, Guimaraes N, Leite M, Figueiredo C, Wengel J, Azevedo NF. Hybridization-based detection of Helicobacter pylori at human body temperature using advanced locked nucleic acid (LNA) probes. PLoS One 2013;8:e81230. 
  23. Santos RS, Dakwar GR, Zagato E, et al. Intracellular delivery of oligonucleotides in Helicobacter pylori by fusogenic liposomes in the presence of gastric mucus. Biomaterials 2017;138:1-12.  https://doi.org/10.1016/j.biomaterials.2017.05.029
  24. Nosrati R, Golichenari B, Nezami A, et al. Helicobacter pylori point-of-care diagnosis: nano-scale biosensors and microfluidic systems. Trends Analyt Chem 2017;97:428-444.  https://doi.org/10.1016/j.trac.2017.10.013
  25. Chao CY, Wang CH, Che YJ, Kao CY, Wu JJ, Lee GB. An integrated microfluidic system for diagnosis of the resistance of Helicobacter pylori to quinolone-based antibiotics. Biosens Bioelectron 2016;78:281-289.  https://doi.org/10.1016/j.bios.2015.11.046