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Journal of Clinical Microbiology, January 2000, p. 13-17, Vol. 38, No. 1
Delft Diagnostic
Laboratory,1 Department of Clinical
Chemistry,2 Department of Infectious
Diseases and Immunology,3 and Department
of Pathology,4 Diagnostic Center SSDZ, and
Department of Internal Medicine, R. de Graaf
Hospital,5 Delft, The Netherlands
Received 14 June 1999/Returned for modification 18 August
1999/Accepted 17 September 1999
A total of 500 consecutive patients undergoing upper endoscopy were
biopsied and tested for H. pylori infection by the
Campylobacter-like organism (CLO) test, culture, histology,
and PCR. Serum samples were tested by two different serological assays.
Patients were considered H. pylori positive if at least two
of the four biopsy specimen-based methods yielded positive results. PCR
had the highest diagnostic sensitivity (99.4%), followed by histology
(92.2%), culture (89.5%), and the CLO test (89.0%). The
specificities of all methods were higher than 98%. Of the organisms
from the 181 PCR-positive patients, the vacA (s and m
regions), cagA, and iceA genotypes were
determined by reverse hybridization (line probe assay) or an
allele-specific PCR. Organisms that were detected by PCR but that
remained undetected by the CLO test were significantly more often
vacA s1 (P = 0.006), m1
(P = 0.028), and cagA positive (P = 0.029) than vacA s2, m2, and
cagA negative, respectively. Organisms that were detected
by PCR but that remained undetected by culture or histology more often
contained iceA1 (P = 0.034 and
P = 0.029, respectively) than iceA2.
Higher H. pylori density was associated with
vacA s2 (P = 0.024), vacA m2
(P = 0.050), and cagA-negative
(P = 0.035) genotypes. Also, the diagnostic results of
the CLO test (P = 0.001) and culture
(P = 0.031) but not those of the PCR
(P = 0.130) were significantly associated with the
H. pylori density. The rate of detection by the four biopsy
specimen-based tests was lower for patients who used proton pump
inhibitors, but this was independent of the H. pylori
genotypes. These observations may be explained by different bacterial
densities, as established by the distinct genotypes of H. pylori, and confirm that the biologies of strains with such
genotypes are considerably different.
0095-1137/0/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
The Efficacy of Laboratory Diagnosis of
Helicobacter pylori Infections in Gastric Biopsy Specimens
Is Related to Bacterial Density and vacA,
cagA, and iceA Genotypes
*
Corresponding author. Mailing address: Delft Diagnostic
Laboratory, R. de Graafweg 7, 2625 AD, Delft, The Netherlands. Phone: 31-15-2604581. Fax: 31-15-2604550. E-mail:
L.J.van.Doorn{at}ddl.nl.
Journal of Clinical Microbiology, January 2000, p. 13-17, Vol. 38, No. 1
0095-1137/0/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
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