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Table 4 H. pylori diagnostic tests and the current situation in Indonesia [64, 71, 72, 92,93,94]

From: Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report

Diagnostic test

Sensitivity (%)

Specificity (%)

Advantage

Disadvantage

Situation in Indonesia

Refs.

Non-invasive test

 

 UBT

95

95

High accuracy

Detects current infection

Less reliable in patients with a history of gastric resection or PPI consumption

13C-UBT and 14C-UBT remain restricted to 4 and 6 cities, respectively

Expensive and uncovered by social insurance

Ongoing validation

[54]

 SAT

66.7–94

78.9–92

Inexpensive and not age dependent

Novel monoclonal antibodies are not influenced by PPIs

ICA-based, does not require special equipment or experts

Inconsistent accuracy based on antigens

Accuracy influenced by incubation time and stool condition

Most centers use ICA-based tests, but with low sensitivity

Collecting stool samples is more difficult than collecting blood samples

[48, 54]

 Serology

66.7–90

80–97.2

Saves costs and reduces the endoscopic workload

Less accurate in children

Wide range of cutoff values

Cannot distinguish between current and past infections

Lower accuracy than ICA-based tests

Validated for some kits. Should not be used solely to diagnose H. pylori infection

[40, 54]

 Urine test

83

95

Easy sampling method without the need for special skills and tools

Sampling is cheaper than serum sampling

False negative results with low concentrations of IgG

Lower accuracy

Requires more time for interpretation;

Lack of availability. Should not be used to diagnose H. pylori infection

[50]

Invasive test

 

 RUT

90

95

Rapid result warranting the fast management for H. pylori eradication

False negative in patients with recent GI bleeding or with the use of PPIs, antibiotics, or bismuth containing compounds

Validated for some kits

[53]

 Histology

42–99

100

Histochemical staging is the standard for H. pylori gastritis assessment Widely available

In cases with low levels of H. pylori, histological stains can provide a negative result

Widely available in Indonesia

[51]

 IHC

65–98

100

IHC staining for H. pylori has a lower inter-observer variation compared to histo- chemical stains

IHC staining procedure is more expensive than histochemical stains and it is not available in all laboratories

In cases of chronic (active) gastritis in which H. pylori is not detected by histochemistry, IHC of H. pylori can be used as an ancillary test

[51]

 Culture

55–73

100

Allows an evaluation of antibiotic resistance irrespective of the intrinsic mechanism involved

H. pylori is difficult to culture

Only available in some centers

[49, 52]