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 | |
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 | |
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 |