Comparison of Different Diagnostic Methods of Helicobacter pylori in Dyspeptic Patients of a Tertiary Care Hospital of Uttarakhand, India

Introduction: Helicobacter pylori (H.pylori) infection is very common worldwide. A reliable diagnosis is crucial for better treatment of the patients. However, there is no single diagnostic method that can meet the criteria in identification of H.pylori. Aim: To detect H.pylori from endoscopic biopsies in dyspeptic patients and to compare the sensitivity and specificity of different diagnostic methods for H. pylori infection. Materials and Methods: This observational and crosssectional study was conducted in the Department of Microbiology and Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months. Biopsies of gastric antrum from 100 patients with dyspepsia were studied for the detection of H.pylori by various methods like bacterial culture, Rapid Urease Test (RUT) and Christensen‘s Tube Urease (CTU) test. Stool samples from all the patients were also screened for H.pylori stool antigen (HpSA) test. Bacterial culture was considered as gold standard in this study and other diagnostic tests were compared with the gold standard. Results: Out of 100 patients H.pylori was detected by bacterial culture, RUT, CTU and HpSA in 34%, 61%, 53% and 28% cases respectively. Sensitivity of RUT, CTU and HpSA were 100%, 91% and 73.5% respectively and specificity of RUT, CTU and HpSA were 59%, 66.7% and 95.3% respectively. Thus, RUT was the most sensitive (100%) and HpSA (95.3%) was the most specific test, when culture was being considered as gold standard. Conclusion: RUT is best considered as a screening test and not as the gold standard for H. pylori. The HpSA test is also rapid, simple and non-invasive test with acceptable results that can be used for monitoring.