Advantages of serological testing for Helicobacter pylori infection as a screening test


  • Premkumar Daivasikamai Department of Surgery, Karpaga Vinayaga Institute of Medical Sciences and Research, Kancheepuram, Tamil Nadu, India


Helicobacter pylori, Serological testing, Stool antigen test, Endoscopy biopsy, Urease breath test, Non-ulcer dyspepsia, Peptic ulcer


Background: As the practicing physicians start treating all dyspeptic symptoms as peptic ulcer disease and some patients are treated for Helicobacter pylori infection without confirmation of infection. Hence, a simple and convenient test to identify the H. pylori infection is essential in the management of all dyspepsia. Serological test is a noninvasive test and result can be obtained within short time and treatment can be started early.

Methods: A total of 86 outpatients with dyspeptic symptoms underwent both serological test and endoscopy and biopsy for H. pylori infection. Serological testing for H. pylori is based on the immunoglobulin G antibody to H. pylori infection.

Results: Of 86 patients, 79 patients’ biopsy were positive for H. pylori and 77 patients were positive by serology. Of them, 75 were both positive for H. pylori by biopsy and also by serology. Those 7, who are negative for histology is also negative for serology. Comparing endoscopic biopsy with serology, the specificity, sensitivity are 97.5, 98 for serology.

Conclusions: Serological tests assess the global presence of H. pylori in the stomach even when the bacteria are irregularly distributed on the gastric mucosa. Serology testing is cheaper and more convenient, and thus should be preferred in situations where the additional information yielded by an endoscopy is not needed.


Yousfi MM, El-Zimaity HM, Cole RA, Genta RM, Graham DY. Detection of Helicobacter pylori by rapid urease tests: is biopsy size a critical variable? Gastrointest Endosc. 1996;43(3):222-4.

Laine L, Chun D, Stein C, El-Beblawi I, Sharma V, Chandrasoma P. The influence of size or number of biopsies on rapid urease test results: a prospective evaluation. Gastrointest Endosc. 1996;43(1):49-53.

Woo JS, el-Zimaity HM, Genta RM, Yousfi MM, Graham DY. The best gastric site for obtaining a positive rapid ureas test. Helicobacter. 1996;1(4):256-9.

van Zwet AA, Thijs JC, Roosendaal R, Kuipers EJ, Peña S, de Graaff J. Practical diagnosis of Helicobacter pylori infection. Eur J Gastroenterol Hepatol. 1996;8(5):501-7.

Talley NJ, Kost L, Haddad A, Zinsmeister AR. Comparison of commercial serological tests for detection of Helicobacter pylori antibodies. J Clin Microbiol. 1992;30(12):3146-50.

Luzza F, Maletta M, Imeneo M, Marcheggiano A, Iannoni C, Biancone L, et al. Salivary-specific immunoglobulin G in the diagnosis of Helicobacter pylori infection in dyspeptic patients. Am J Gastroenterol. 1995;90(10):1820-3.

Fallone CA, Elizov M, Cleland P, Thompson JA, Wild GE, Lough J, et al. Detection of Helicobacter pylori infection by saliva IgG testing. Am J Gastroenterol. 1996;91(6):1145-9.

Graham DY, Evans DJ Jr, Peacock J, Baker JT, Schrier WH. Comparison of rapid serological tests (FlexSure HP and QuickVue) with conventional ELISA for detection of Helicobacter pylori infection. Am J Gastroenterol. 1996;91(5):942-8.

Moayyedi P, Carter AM, Catto A, Heppell RM, Grant PJ, Axon AT. Validation of a rapid whole blood test for diagnosing Helicobacter pylori infection. BMJ. 1997;314(7074):119.

Jones R, Phillips I, Felix G, Tait C. An evaluation of near-patient testing for Helicobacter pylori in general practice. Aliment Pharmacol Ther. 1997;11(1):101-5.

Reilly TG, Poxon V, Sanders DS, Elliott TS, Walt RP. Comparison of serum, salivary, and rapid whole blood diagnostic tests for Helicobacter pylori and their validation against endoscopy based tests. Gut. 1997;40(4):454-8.

Mowat C, Murray L, Hilditch TE, Kelman A, Oien K, McColl KE. Comparison of helisal rapid blood test and 14C-urea breath test in determining Helicobacter pylori status and predicting ulcer disease in dyspeptic patients. Am J Gastroenterol. 1998;93(1):20-5.

Vaira D, Holton J, Menegatti M, Landi F, Ricci C, Ali A, et al. Blood tests in the management of Helicobacter pylori infection. Italian Helicobacter pylori Study Group. Gut. 1998;43 Suppl 1:S39-46.

Mendall MA, Goggin PM, Marrero JM, Molineaux N, Levy J, Badre S et al. Role of Helicobacter pylori serology in screening prior to endoscopy. Eur J Gastroenterol Hepatol. 1992;4:713-7.

Patel P, Khulusi S, Mendall MA, Lloyd R, Jazrawi R, Maxwell JD, et al. Prospective screening of dyspeptic patients by Helicobacter pylori serology. Lancet. 1995;346(8986):1315-8.

Denis P, De Koster E, Nyst JF, Deltenre M. HP serology as a screening method prior to upper gastro-intestinal endoscopy in young dyspeptic patients: a different point of view. Acta Gastroenterol Belg. 1995;58(5-6):378-81.

Briggs AH, Sculpher MJ, Logan RP, Aldous J, Ramsay ME, Baron JH. Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age. BMJ. 1996;312(7042):1321-5.

Olson AD, Fendrick AM, Deutsch D, Chernew ME, Hirth RA, Patel C, et al. Evaluation of initial noninvasive therapy in pediatric patients presenting with suspected ulcer disease. Gastrointest Endosc. 1996;44(5):554-61.

Sonnenberg A. Cost-benefit analysis of testing for Helicobacter pylori in dyspeptic subjects. Am J Gastroenterol. 1996;91(9):1773-7.

Forman D. The prevalence of Helicobacter pylori infection in gastric cancer. Aliment Pharmacol Ther 1995;(9 Suppl 2):71-6.

Parsonnet J, Harris RA, Hack HM, Owens DK. Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: a mandate for clinical trials. Lancet. 1996;348(9021):150-4.

Glupczynski Y. Microbiological and serological diagnostic tests for Helicobacter pylori: an overview. Br Med Bull. 1998;54(1):175-86.

NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in peptic ulcer disease. JAMA. 1994;272(1):65-9.

Lin SY, Jeng YS, Wang CK, Ko FT, Lin KY, Wang CS, et al. Polymerase chain reaction diagnosis of Helicobacter pylori in gastroduodenal diseases: comparison with culture and histopathological examinations. J Gastroenterol Hepatol. 1996;11(3):286-9.

Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, et al. Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard. Am J Gastroenterol. 1996;91(10):2125-9.

Klein PD, Malaty HM, Martin RF, Graham KS, Genta RM, Graham DY. Noninvasive detection of Helicobacter pylori infection in clinical practice: the 13C urea breath test. Am J Gastroenterol. 1996;91(4):690-4.

Cutler AF, Havstad S, Ma CK, Blaser MJ, Perez-Perez GI, Schubert TT. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995;109(1):136-41.

Hamlet AK, Erlandsson KI, Olbe L, SvennerholmWAM, Backman VE, Pettersson AB. A simple, rapid, and highly reliable capsule-based 14C urea breath test for diagnosis of Helicobacter pylori infection. Scand J Gastroenterol. 1995;30(11):1058-63.

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(8):1921-30.

Chang MC, Wu MS, Wang HH, Wang HP, Lin JT. Helicobacter pylori stool antigen (HpSA) test – A simple, accurate and non-invasive test for detection of Helicobacter pylori infection. Hepatogastroenterology. 1999;46(25):299-302.






Original Research Articles