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Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors.

Authors
  • Gastli, Nabil1
  • Allain, Margaux1
  • Lamarque, Dominique2
  • Abitbol, Vered3
  • Billoët, Annick1
  • Collobert, Gislène1
  • Coriat, Romain3
  • Terris, Benoit4
  • Kalach, Nicolas5
  • Raymond, Josette1, 6, 7
  • 1 Service de Bactériologie, AP-HP Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France. , (France)
  • 2 Gastroentérologie, Hôpital Ambroise Paré, AP-HP, Université Versailles-Saint Quentin-en-Yvelines, 92100 Boulogne, France. , (France)
  • 3 Gastroentérologie, AP-HP Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France. , (France)
  • 4 Anatomopathologie, AP-HP Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France. , (France)
  • 5 Clinique pédiatrique Saint Antoine, Hôpital Saint Vincent de Paul, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), 59020 Lille, France. , (France)
  • 6 Service de Bactériologie, AP-HP Université Paris-Saclay, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France. , (France)
  • 7 Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France. , (France)
Type
Published Article
Journal
Journal of Clinical Medicine
Publisher
MDPI AG
Publication Date
Jun 23, 2021
Volume
10
Issue
13
Identifiers
DOI: 10.3390/jcm10132755
PMID: 34201588
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Reliable diagnostic methods are mandatory for effective management of Helicobacter pylori infection. Histology and culture are the most common invasive methods in current practice, even if molecular methods are gaining in importance. The performance of these conventional methods varies significantly. We conducted a retrospective study of 1540 adults and 504 children with gastric biopsies taken during endoscopy to assess the impact of bacterial load and the cagA virulence factor on the performance of H. pylori infection testing. The association between virulence and histology findings was also investigated. With 23S rRNA qPCR confirmed by glmM amplification as the gold standard, culture and histology had lower sensitivity, 74.4% and 73.3%, respectively. However, their sensitivity was enhanced (>90%) in biopsies with high bacterial load (qPCR Ct < 30). Positive cagA status of the strain was associated with high bacterial load (94.9%), thus resulting in more frequent positive culture (94.3%) and H. pylori histology detection (91.7%) and more severe lesions on histology (p < 0.001). Conversely, the cagA status of the strains was negative in 110/119 (92.4%) of biopsies with low bacterial load (qPCR Ct < 30), 82/90 (91.1%) with negative H. pylori histology detection and 119/131 (90%) with negative culture findings (p < 0.001). This study highlights the low sensitivity of conventional culture and histology that may lead to false negative diagnosis if used alone. H. pylori quantification associated with cagA genotyping in routine workflow are essential for a sensitive and reliable diagnosis, to identify patients at high risk and to manage eradication therapies.

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