Helicobacter pylori are the most prevalent chronic bacterial infection. It is associated with peptic ulcer disease, chronic gastritis, gastric adenocarcinoma and gastric Mucosa Associated Lymphoid Disease (MALT) lymphoma. HpSA Enzyme Immunoassay (EIA) is an in vitro qualitative procedure for the detection of Helicobacter pylori antigens in human stool. Test results are intended to aid in the diagnosis of H. pylori infection and to monitor response during and post therapy in patients.

Keywords: HpSA, Endoscopy, PPI, UBT

INTRODUCTION

Helicobacter pylori are the most prevalent chronic bacterial infection and are associated with peptic ulcer disease, chronic gastritis, gastric adenocarcinoma and gastric Mucosa Associated Lymphoid Tissue (MALT) lymphoma [1,2]. It is a Gram-negative, microaerophilic bacterium usually found in the stomach. The Australian scientists Barry Marshall and Robin Warren found it in the stomach of a person in 1982 with chronic gastritis and gastric ulcers. It was not previously believed to have a microbial cause [3]. It is also linked to the development of duodenal ulcers and stomach cancer [4]. However, over 80% of individuals infected with the bacterium are asymptomatic. In recognition of their discovery, Marshall and Warren were awarded the 2005 Nobel Prize in Physiology or Medicine. Upto 90% of people infected with H. pylori never experience symptoms [5]. Acute infection may appear as an acute gastritis with abdominal pain or nausea. This develops into chronic gastritis and non-ulcer dyspepsia: stomach pains, nausea, bloating, belching and sometimes vomiting or black stool [6].

CASE REPORT

A 65 year old female was suffering from acid peptic disease with epigastric pain since last 20 years. She was treated with proton-pump inhibitors such as omeprazole. She was afraid of taking any spicy or non-vegetarian food which increased the symptoms. She was not tolerating citrus fruits and milk products except curd. She was a non-diabetic and moderately hypertensive. Ultrasound scanning of whole abdomen was done. No significant abnormality was detected. Upper GI endoscopy suggested mucosal hyperemia with erosions in the antrum and multiple tiny superficial ulcers with nodularity over anterior and superficial wall in the first part of duodenum. The rapid urease test was found positive. Enzyme immunoassay for the detection of monoclonal antigens of Helicobacter pylori in stool found positive in high titer. Two courses of triple drug therapy were given at two weeks interval. The HpSA test became negative.

DISCUSSION

Helicobacter pylori is now recognized as one of the most common and medically important pathogen worldwide [7]. The diagnostic test for H. pylori can be categorized as invasive (endoscopy, biopsy, culture) or non-invasive (stool antigen test, carbon urea breath test and blood antibody tests). An endoscopic biopsy is an invasive means to test H. pylori infection. Low level of infection can be missed by biopsy. So multiple samples are recommended. The most accurate method for detecting the bacteria is with histological examination from two sites after endoscopy biopsy, combined with either a rapid urease test or microbial culture [8].

CONCLUSION

Endoscopy is not indicated solely for the purpose of establishing H. pylori status. Stool antigen test is the choice of test for diagnosis and eradication of the bacteria .It is the most cost effective test in areas of low to intermediate prevalence of H. pylori.

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