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

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...

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Autores principales: Gastli, Nabil, Allain, Margaux, Lamarque, Dominique, Abitbol, Vered, Billoët, Annick, Collobert, Gislène, Coriat, Romain, Terris, Benoit, Kalach, Nicolas, Raymond, Josette
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268826/
https://www.ncbi.nlm.nih.gov/pubmed/34201588
http://dx.doi.org/10.3390/jcm10132755
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author Gastli, Nabil
Allain, Margaux
Lamarque, Dominique
Abitbol, Vered
Billoët, Annick
Collobert, Gislène
Coriat, Romain
Terris, Benoit
Kalach, Nicolas
Raymond, Josette
author_facet Gastli, Nabil
Allain, Margaux
Lamarque, Dominique
Abitbol, Vered
Billoët, Annick
Collobert, Gislène
Coriat, Romain
Terris, Benoit
Kalach, Nicolas
Raymond, Josette
author_sort Gastli, Nabil
collection PubMed
description 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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spelling pubmed-82688262021-07-10 Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors Gastli, Nabil Allain, Margaux Lamarque, Dominique Abitbol, Vered Billoët, Annick Collobert, Gislène Coriat, Romain Terris, Benoit Kalach, Nicolas Raymond, Josette J Clin Med Article 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. MDPI 2021-06-23 /pmc/articles/PMC8268826/ /pubmed/34201588 http://dx.doi.org/10.3390/jcm10132755 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gastli, Nabil
Allain, Margaux
Lamarque, Dominique
Abitbol, Vered
Billoët, Annick
Collobert, Gislène
Coriat, Romain
Terris, Benoit
Kalach, Nicolas
Raymond, Josette
Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors
title Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors
title_full Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors
title_fullStr Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors
title_full_unstemmed Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors
title_short Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors
title_sort diagnosis of helicobacter pylori infection in a routine testing workflow: effect of bacterial load and virulence factors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268826/
https://www.ncbi.nlm.nih.gov/pubmed/34201588
http://dx.doi.org/10.3390/jcm10132755
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