the Discrepancy in H. Pylori Testing: A Patient's Journey

Q: the Discrepancy in H. Pylori Testing: A Patient's Journey

Hello： There are two methods for detecting Helicobacter pylori during an upper gastrointestinal endoscopy. <br>One method involves taking a biopsy, which is then examined by a pathologist under a microscope to check for the presence of Helicobacter pylori in the gastric tissue. <

Helicobacter pylori

Hello Doctor: I have been experiencing recurrent abdominal pain, so I visited a gastroenterologist for an examination.
After undergoing an endoscopy, the doctor mentioned that there were some abrasions in my stomach, but no Helicobacter pylori was detected.
I was prescribed Ulcerin capsules, Gascol tablets, magnesium oxide tablets, and Rockefel granules.
After taking these medications for two weeks, I still experienced stomach pain.
Upon my follow-up visit, I underwent a breath test, which this time indicated a positive result for Helicobacter pylori.
Could the endoscopy results have been inaccurate? Why was Helicobacter pylori not detected during the endoscopy, but tested positive two weeks later with the breath test?

Du Ruo, 20~29 year old female. Ask Date: 2021/09/30

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: There are two methods for detecting Helicobacter pylori during an upper gastrointestinal endoscopy.
One method involves taking a biopsy, which is then examined by a pathologist under a microscope to check for the presence of Helicobacter pylori in the gastric tissue.
If the biopsy does not contain Helicobacter pylori or if the bacterial load is too low, it may be incorrectly diagnosed as negative.
The other method involves culturing the biopsy sample on a rapid urease test plate (CLO test).
A color change indicates a positive result; however, if the bacterial load is too low (resulting in a slight color change) or if the sample does not contain bacteria, this may also lead to inaccuracies.
Therefore, a positive breath test should be considered indicative of Helicobacter pylori infection.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2021/09/30

More Info

The situation you are describing regarding the discrepancy in Helicobacter pylori (H. pylori) testing results is not uncommon and can be attributed to several factors related to the nature of the tests, the timing of the tests, and the biological behavior of H. pylori itself.

Firstly, it's essential to understand that there are multiple methods for detecting H. pylori, including endoscopic biopsy, breath tests, stool antigen tests, and serological tests. Each method has its own sensitivity and specificity, which can lead to variations in results. In your case, the initial endoscopic biopsy did not reveal the presence of H. pylori, while the subsequent breath test indicated a positive result.

One possible explanation for this discrepancy is the timing of the tests. H. pylori can be present in the stomach in varying quantities, and its detection can depend on several factors, including the presence of active inflammation or ulceration. If the bacteria were present but not actively colonizing the mucosa at the time of the biopsy, it might not have been detected. Additionally, if you had been on any medications that affect gastric pH, such as proton pump inhibitors (PPIs), this could have influenced the results of the biopsy. PPIs reduce stomach acid, which can create an environment less conducive to the growth of H. pylori, potentially leading to false-negative results.

Moreover, the breath test you underwent later is designed to detect active infection by measuring the presence of urease, an enzyme produced by H. pylori. If the bacteria were present but not actively causing inflammation at the time of the biopsy, they might have been detected later when the conditions in your stomach changed, or when the bacterial load increased.

Another factor to consider is the possibility of sampling error during the biopsy. The stomach is a large organ, and if the biopsy samples were taken from an area without H. pylori, the test would return negative. Conversely, the breath test assesses the overall presence of the bacteria in the stomach, which may yield a different result.

Given your ongoing symptoms of gastric pain, it is crucial to follow up with your healthcare provider. They may recommend a treatment plan that targets H. pylori, especially since it is associated with conditions such as gastritis and peptic ulcers. Treatment typically involves a combination of antibiotics and acid-reducing medications to eradicate the bacteria and promote healing of the gastric lining.

In summary, discrepancies in H. pylori testing can arise from various factors, including the type of test used, the timing of the tests, the influence of medications, and the potential for sampling error. It is essential to communicate openly with your healthcare provider about your symptoms and test results to ensure appropriate management and treatment. If you continue to experience gastric pain despite treatment, further evaluation may be necessary to rule out other underlying conditions.

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