Disease

Diagnosis of Helicobacter pylori: antibodies, breath test and biopsy

Most people, especially those suffering from ulcers and gastritis, are well aware of the term “Helicobacter pylori. The presence in the body of a spiral bacterium is accompanied by the appearance of discomfort in the epigastric region, the development of diseases of the gastrointestinal tract. For certain symptoms, a Helicobacter test is indicated for FGDs before treatment. This is the most reliable diagnosis of infection with an insidious bacterium. Testing is performed by several methods, but the most effective gastroscopy with the intake of mucus from suspicious sections of the stomach.

Overview of Helicobacter pylori

The digestive system reacts to the presence of Helicobacter in the body with a number of dangerous diseases, the cause of which is the toxic effect of the bacterial waste products. The microorganism colonizing the lower part of the stomach is able to exist in conditions of a high level of acidity of the medium, quickly migrating due to spiral flagella. The ability to produce urease (a protective enzyme) provides Helicobacter pylori protection against gastric juice, the contact method is considered the main method of infection.

Infection of the human body Helicobacter pylori for a long time may go unnoticed. Intruding into the walls of the stomach, the microorganism promotes the active synthesis of hydrochloric acid, gastrin, pepsin, which results in the dissolution of mucosal cells with the appearance of characteristic symptoms of helicobacteriosis:

  • acid reflux, heartburn,
  • pain symptom in the epigastric zone during and after meals,
  • signs of impaired digestion - flatulence, bloating,
  • fast satiety or constant hunger,
  • dysbiosis, allergies, fungal infections.

Interesting facts: a spiral bacterium, classified as a gram-negative microorganism, was accidentally discovered by German scientists in 1875. By the end of the last century, a Russian professor had encountered a similar organism, and Australian pathologists were lucky to cultivate the bacterium for the first time. After that, the medical community had to recognize Helicobacter pylori as the culprit of gastric pathologies.

Types of Helicobacter Testing

  1. Respiratory diagnosis. The study is effective and absolutely safe, allows you to accurately identify traces of the waste products of the bacterium with two exhaled subjects. The test is based on the ability of the pathogen to produce urease, which protects the amoeba from aggression of gastric juice. The result of urease tests is the reaction of Helicobacter pylori to a patient's solution with a special type of isotopic substance. The process of quick diagnosis, which has no contraindications, is highly reliable (up to 95%), but only with the correct preparation for the procedure.
  2. Blood test The task of the test is to determine the presence in the blood of antibodies that the human immune system produces upon contact with the pathogen. The presence or absence of an extraneous microbe is determined by the reference (threshold) value of the volume of immunoglobulins. If there are no foreign proteins, the result is considered negative, the presence of antigens (positive result) indicates infection. However, even with a negative sample, there is no guarantee that infection will not occur.
  3. The study of feces. The test, called PCR diagnostics, refers to the methods of polymerase chain reaction, is considered the most sensitive way to recognize the DNA of the pathogen. To obtain reliable results, it is necessary to prepare for the material intake in a certain way, then the accuracy of detection of DNA fragments of the Helicobacter pylori microbe reaches 96%.
  4. Gastroscopy with sampling for research. The endoscopic procedure has the unique ability to visually inspect the walls of the digestive tract through the eyepiece of the gastroscope to determine the cause of the disease. If problem areas are detected, the doctor performs a biopsy sample for subsequent diagnosis of the presence of Helicobacter pylori in the cells of the walls of the stomach. The invasive method is called the HP test, the study eliminates the likelihood of a false result.

An unexpected aspect: some gastroenterologists are not inclined to classify Helicobacter pylori as a detachment of harmful microbes. Bacteria are considered part of the protective microflora of the human body (by analogy with lactobacilli). A person needs treatment only if an ulcer or erosion is detected. It turns out that the microbe is considered a protector against intestinal infections, asthma (bronchial), some types of oncology.

Features of gastroscopy with the definition of Helicobacter pylori

Gastroscopy with a Helicobacter test allows you to visualize the work of the stomach, find out the cause of the unpleasant symptoms of stomach ailments, the culprit of which may be the famous bacterium. The endoscopic procedure is completely safe, not only detects helicobacteriosis, but also helps to establish the stage of its development. As with the breath test, the reliability of the results of gastroscopy with biopsy selection is based on the ability of Helicobacter pylori to urease the reaction - splitting urea with the release of carbon dioxide, which protects the amoeba from the acidic environment of the stomach.

The main advantage of the HP test is the unique ability to select a fragment of the gastric mucosa for fixing the urease activity of the microorganism in a special environment. The stages of the Helicobacter test in fibrogastroduodenoscopy (FGDS) are as follows:

  • to reduce the level of discomfort, the patient's throat is treated with a local anesthetic,
  • an endoscopic probe equipped with a light source for examining the surface of the organ is inserted through the rubber ring of the mouthpiece into the stomach area
  • after a thorough examination of the problem area, the doctor, using biopsy forceps (sterile), takes a sample of the mucosa for analysis.

Endoscopic diagnosis requires some preparation, the main condition of which is testing for an empty stomach, preferably in the early morning. In addition, three days before the procedure, the patient should exclude alcohol consumption, stop smoking immediately before fibrogastroscopy (FGS).

Research Methods for Selected Material

  • Rapid testing for Helicobacter pylori

An easy-to-use test ensures the speed of obtaining reliable results. The essence of the technique is the placement of the selected sample in a solution of a special chemical composition. If the biopsy specimen contains the waste products of a spiral-type bacteria, the yellow color of the solution with the reagents becomes bright red. The rate of reddening of the liquid depends on the quantitative composition of microorganisms, usually with a large volume of metamorphosis with the solution, a maximum of two hours occurs. The unchanged color of the fluid with the selected material indicates the absence of Helicobacter pylori in the stomach.

  • Methodology of cytological research

Testing, which allows to determine the presence or absence of infection, takes place in a laboratory using a powerful microscope that provides a 360-fold increase. The technique demonstrates the most accurate test results with the complete exclusion of false positive options with the condition of complete cancellation before the test for taking any medication. Especially antibiotics that distort the results of any kind of analysis.

Distinguishing Helicobacter from friendly microflora in samples of mucus or gastric tissue is quite simple because of its unusual shape. The oblong-shaped spiral amoeba is equipped with additional antennae. Such devices help the microorganism penetrate into the tissues of the mucous membrane of the stomach and duodenum, as well as the upper layer of the digestive organ, in order to avoid the destructive effect of gastric acid.

Why is biopsy so important

The collection of a tiny piece of tissue (biopsy) is necessary to study its cellular composition. With a multiple increase, the technique reveals with a high degree of certainty the cause of the disease or the presence of a tumor at an early stage. The procedure for examining the organs of the gastrointestinal tract is performed by a gastroscope, which is a rather long flexible tube equipped with a light source, an optical system, and also a biopsy tool. The process of manipulation is shown on the monitor screen.

The material obtained during gastroscopy is necessary for two types of research:

  • histological analysis is a cellular study of the tissue structure of the selected material for the presence of antibodies to Helicobacter,
  • along the cytology, the taken material is examined to determine the number of bacteria in the area examined under the microscope, as well as to detect atypical cells.

A gastroscopy technique with a biopsy refers to the most reliable types of diagnostics of not only Helicobacter pylori, but also malignant tumors. This is an important material for the accuracy of the diagnosis, the choice of a certain type of treatment.

Information for consideration. The biggest danger is Helicobacter pylori in its poor knowledge. Doctors still cannot explain why some people do not suffer from ulcers and gastritis, unlike other infected people. It is also not completely clear to what extent the fact of the presence of bacteria in the body is associated with a risk of developing stomach cancer. Therefore, the task of the coming years is the creation of a vaccine against infection, the development of effective antibiotics free of resistance. To date, the only preventative measure for a controversial issue is the test for the presence of Helicobacter pylori.

Benefits

  • accessible to all patients
  • not accompanied by severe discomfort and stress during the procedure (injection method of blood sampling),
  • taking medications used to treat diseases of the stomach and duodenum does not affect the result of the study.

Procedure

Blood sampling is performed by venipuncture. The material is taken into a sterile vacuum tube with a coagulation activator for rapid separation of serum. Blood is delivered to the laboratory within 2 hours. Serum microtubes may be stored in the refrigerator at a temperature of 2-8 ° C or in the freezer at -20 ° C for up to 10 days.

Method Features

Enzyme-linked immunosorbent assay - ELISA is used to detect bacteria. This laboratory method involves the study of blood serum. Through chemical reactions, doctors determine the presence of antibodies in it - specific proteins of an immunological nature that are released when various antigens that are not familiar to him (foreign bacteria, viruses, fungi, toxins, allergens, etc.) are exposed to the human body. Helicobacter pylori is an infectious causative agent of gastropathology. When it enters the gastrointestinal tract, it activates the immune system and causes the production of antibodies - immunoglobulins (Ig). ELISA helps diagnose the presence or absence of this infection.

There are situations when the detected antibodies in the blood serum is a false positive result. This may be due to the prolonged circulation of immunoglobulins in the plasma after the destruction of bacteria due to eradication therapy. Antibodies are present in the blood for a month after treatment, and some remain for life. In the other case, the opposite is true. There is infection, and antibodies in the blood serum are not detected (false-negative result). This may be due to an early period after infection. Antibodies do not have time to develop due to a weak immune response. To avoid inaccuracies in the results, it is necessary to further study the fractions of immunoglobulins of 3 species: M, G, A.

Characteristics of specific blood proteins:

  • IgM - determined immediately after infection, until IgG is detected.
  • IgG - It is produced 3-4 weeks after ingestion of an infectious “agent”. The concentration of this class of immunoglobulins directly depends on the initiation of eradication therapy. A false-positive result for antibodies to Helicobacter pylori persists for a month after the complete destruction of the pathogen.
  • IgA - secretory immunoglobulin. May be detected in blood, saliva, and gastric juice. Indicates the severity of the inflammatory process. Appears in the blood after 2-3 weeks from the moment of infection, can circulate for several years.

Decryption of analysis

There is a qualitative and quantitative determination of antibodies to Helicobacter pylori. In the first case, the presence of specific immunoglobulins is diagnosed, and in the second, their concentration. A qualitative analysis determines the total antibodies (IgM, IgG, IgA). In a quantitative study, the norms for the content of specific proteins in the blood are used.

Each laboratory has its own reference values ​​used for a certain type of reagent.

What is Helicobacter pylori?

This is a spiral-shaped bacterium that appears and lives on the mucous membrane of the stomach and duodenum. It provokes inflammation of the mucous membranes, their ulceration and even contributes to the appearance of malignant cells. Studies confirm that it affects at least 70% of the entire population, while 90 out of a hundred people do not show it.

The spiral shape and additional antennae facilitate the penetration of the microorganism into the mucosa and upper layers of the digestive organs. The bacterium produces several substances:

When exposed to adverse external factors, such as antibiotics, or when the acidity in the stomach changes, the microorganism forms a film on the surface of the cells that protects them from destruction. Another defensive reaction is a change in shape from spiral to round.

Discovery story

Helicobacter pylori was discovered by chance in the late 19th century. The Polish scientist Valery Yavorsky discovered it by studying the fluid remaining from washing a person’s stomach. He suggested that this bacterium is involved in the development of many diseases of the stomach. His discovery was not recognized in medicine, and the microorganism was forgotten for 100 years.

In 1979, a pathologist from Australia, Robert Warrens, discovered a bacterium in a person’s stomach. Together with Barry Marshall, they began to further study the microorganism. They managed to cultivate it artificially and study its properties in detail.

In 1981, they made a sensational discovery: stress and spicy foods cause far fewer cases of gastritis and ulcers than Helicobacter pylori. The reliability of their discovery and an effective method of treating gastritis, they have shown in their experience. For their contribution to medicine, Marshall and Warren received the Nobel Prize in 2005.

Routes and symptoms of Helicobacter pylori infection

Helicobacter bacterium is very easy to get infected. The most common ways:

  • through dirty water
  • by contact.

The microorganism is easily transmitted through touch, when coughing and sneezing. The household pathway for bacteria to enter the body is very common in families where at least one person is a carrier.

The peculiarity of the microorganism is that it is in a sleeping state as long as the body's defenses show resistance.As soon as immunity is reduced, Helicobacter pylori manifests itself. The bacterium begins to multiply rapidly, the products of its vital activity poison the body and cause inflammation of the mucous membranes of the duodenum and stomach. The cause of this may be a past illness or stress.

In most cases, doctors and people themselves do not associate the appearance of gastric pathologies with the action of the body and begin a long but unsuccessful treatment.

Signs of Helicobacter pylori infection are:

  • frequent heartburn, resulting in an attack of nausea,
  • systematic diarrhea or diarrhea,
  • bouts of pain in the stomach
  • belching after eating,
  • allergic reactions that are associated with rejection of certain products,
  • change in bad breath to very untidy.

The vital activity of the microorganism affects the condition of nails and hair. The hair is noticeably thinning and losing its healthy appearance. The nails become dry and brittle; spots may appear on them.

What diseases does Helicobacter pylori provoke?

Helicobacter pylori can be in the body for several years, absolutely not manifesting itself. As soon as favorable conditions occur (for example, immunity decreases), the bacterium begins to rapidly divide, while secreting enzymes that destroy the mucous membrane of the duodenum and stomach. This contributes to the penetration of bacteria into the body and the development of certain diseases:

  • gastritis,
  • inflammation of the mucous membrane of the duodenum (duodenitis),
  • peptic ulcer
  • stomach lymphoma
  • cancerous growths.

Malignant tumors appear in the digestive organs if you do not treat for a long time.

Basic diagnostic methods

If a gastroenterologist suspects the presence of helicobacteriosis in a patient, he can prescribe him one of the diagnostic methods:

  1. Laboratory examination of feces for the presence of antibodies and waste products of the Helicobacter bacterium in it.
  2. Blood test for antibodies. If they are detected, this means that the human immune system is trying to fight the microorganism.
  3. A specific test that detects the presence of bacteria vital products during human breathing.
  4. Cytology analysis of a small piece of mucosa. A biopsy is performed using a flexible gastroscope.

Each method has its own characteristics, advantages and disadvantages.

Fecal Helicobacteriosis

Diagnostics Helicobacter in this way is highly accurate. Reliability is more than 90%. It is recommended to conduct a study before the start of therapeutic measures, since some drugs can distort the accuracy of the data obtained.

For analysis, feces obtained after natural defecation are used. Stimulation of bowel movement by enema or laxatives does not guarantee the correct result. In feces there should not be urine, mucus, blood impurities. It also affects the outcome of the study.

A few days before the test, it is recommended to exclude from the diet products with artificial and natural dyes and dishes with a high fiber content. Under the ban, any medications that can change the composition of feces or affect the vital activity of microorganisms.

Examination of feces for the presence of Helicobacter antigens is usually used to diagnose children, the elderly and patients in serious physical condition.

The decryption of the analysis data contains 2 answers: positive and negative. Antigens can be detected in the feces when they are present and active, and for some time after their death. A negative answer is received in two cases: in case of violation of technology or recommendations and in the real absence of bacteria.

  • does not require a personal presence,
  • does not injure a person.

  • the effect on the result of many factors (medication, consumed products),
  • the probability of death of Helicobacter pylori in an aggressive environment of feces.

Laboratory blood test

Another way to detect Helicobacter pylori without gastroscopy is to study the patient’s blood in a laboratory.

Similar tests are given before lunch. Before manipulation, it is not recommended to eat spicy and fatty foods during the day. On the day of the procedure, you can drink tea without sugar, you can not eat.

The material for analysis is venous blood. It is placed in a centrifuge with a special solution that accelerates the folding and separation of plasma. The resulting material is examined for the presence of antibodies to Helicobacter bacteria.

Antibodies - the result of the struggle of human immunity with penetrated from the outside. If they are determined, then the body has recognized them and is struggling. By the number of antibodies, you can determine the time elapsed from the moment of activation, and the stage of the pathological process.

The obtained indicators are compared with normal and reach a verdict. A slight excess of the norm can be detected even in a person without gastrointestinal tract pathologies. The presence of antibodies in large quantities is a sign of microorganism activity.

The advantage of this method can be called a relatively painless sampling of the material.

The disadvantage is the lack of antibodies in the blood at the initial stage of the disease and their presence after cure.

Helicobacter pylori breath test

This method is based on the ability of a spiral bacterium to secrete certain products. The breath test responds to urease. This waste product of a pathogenic bacterium protects it from an acidic environment, splitting it into carbon dioxide and ammonia.

Currently, 3 types of analysis are used:

  1. Test with urea labeled with radioactive carbon. The procedure is quite lengthy. To begin with, the patient breathes into a tube with an open mouth. The specialist takes 2 samples. Then you need to drink a urea solution and after a quarter of an hour pass another 4 breath tests. It is very important that the exhaled air does not mix with saliva. If this happens, the patient is offered to repeat the manipulations after an hour.
  2. Test with urea labeled with non-radioactive carbon 13C. The procedure takes only 30-40 minutes. First, the patient exhales air in a special package. You need to do this in the morning and on an empty stomach. Then you should drink the urea solution and breathe in the bag again.
  3. Helic test. The loading solution in this case contains urea. The patient gives 2 samples, which are compared with normal rates.

In order for the test results to be reliable, the following recommendations must be observed:

  • in 10-14 days to exclude or limit the intake of certain medications,
  • give up alcohol and strong coffee in 72 hours,
  • exclude fatty and gas-forming foods per day,
  • it is advisable not to drink on the day of the procedure (allow 50-100 ml of liquid)
  • Do not smoke or chew gum before testing.

Each type of breath test has its advantages. Tests that use labeled urea are highly accurate and do not cause discomfort to the patient. Their disadvantage is that they are unsafe for some people.

The test with urea can be done even by young children and expectant mothers, but it is often mistaken.

The result of this diagnostic method is affected by the use of antibiotics and medications that reduce the secretion of gastric juice.

The above methods are most often used together.

Gastroscopy with Helicobacter pylori test

One of the most effective ways to determine the Helicobacter bacterium in the body is to conduct a conventional gastroscopy of the stomach with the simultaneous collection of material for cytology. Diagnosis allows you to identify the microorganism even when it is in a sleeping state and left no traces in the feces and urine.

Sampling takes place when examining the upper gastrointestinal tract with a gastroscope.

The procedure is as follows:

  • tongue root and upper esophagus are anesthetized with lidocaine solution,
  • atropine solution is injected under the patient’s skin, it has a sedative effect,
  • after 20-30 minutes, the patient is asked to lie down on the left side with a straight back,
  • a gastroscope tube is inserted through the mouthpiece and, following the breath, is lowered down.

As soon as the device reaches the stomach, the specialist begins to examine its surface. If a part with signs of inflammation or a large amount of mucus is found, a sample is taken. Plots with ulcers are not suitable for the collection of material, since it is proved that bacteria do not survive here due to severely damaged mucous membranes.

The material can be examined in two ways: place it in a special environment (rapid test) or conduct cytological analyzes.

The results of the express test are ready in a day. It is carried out quite simply: the tissues are placed in a special yellow solution, which changes its color to bright red due to the waste products of the spiral bacterium. The speed of metamorphosis depends on the number of microorganisms. If there are a lot of them, the liquid turns red after 1-2 hours. If the solution does not change color after a day, this means that it does not contain Helicobacter pylori.

A cytological examination is carried out in the laboratory under a powerful microscope, magnifying 360 times. Helicobacter pylori bacteria are very easy to detect in the mucus or tissues of the stomach: they differ in form from other microorganisms. The laboratory assistant draws attention to the number of microorganisms in one sample.

Preparation for such a study consists in refusing for 10-12 hours from food, cigarettes, drugs and heavy drinking on the day of the procedure.

Gastroscopy with a biopsy to detect Helicobacter pylori is the most accurate method for determining microorganisms. It is absolutely safe, and pain can be eliminated with local or general anesthesia. Some clinics offer to carry out the procedure in a short medication sleep.

Treatment and prevention

Therapy of patients with Helicobacter pylori is carried out in 2 directions:

  • taking antibiotics that are detrimental to microorganisms,
  • the use of drugs that change the level of acidity.

Complex treatment leads to the death of a spiral bacterium. As a result, in patients with a diagnosed ulcer (gastritis), mucosal regeneration begins, and in people without any signs of the disease, the pathology does not develop.

There are many disputes among gastroenterologists about the feasibility of destroying the spiral bacteria. Complete eradication in some cases is very difficult, since Helicobacter pylori develops immunity to those groups of medicines that were previously prescribed to suppress other pathologies.

Strong antibiotics that are used in treatment adversely affect the entire microflora of the digestive system, so this therapy is fraught with dysbiosis and problems with stool.

The direction and method of treatment is chosen by the doctor, taking into account the general condition of the patient and the degree of insemination of his mucous membranes with a spiral bacterium.

Helicobacter pylori is affected by the lifestyle of a person. To prevent infection, it is necessary to observe personal hygiene and avoid factors that reduce the body's defenses.

If in the family one person has gastritis or an ulcer, then the rest of the members will not be prevented from being tested for the presence of a spiral bacterium. The best way to make an accurate diagnosis even at an early stage is to do a gastroscopy. Choosing a clinic, you need to be interested before conducting endoscopy, whether additional research on Helicobacter is included here.

The danger lurking for years

In most cases with FGDS, the pathogen microorganism Helicobacter pylori is found in the stomach of the subject, which is the causative agent of gastritis, peptic ulcer and oncological processes. How does infection happen?

You can become infected with this bacterium when the saliva of a sick person enters the body, for example, if you do not adhere to sanitary standards when kissing or using common dishes. Helicobacter can be obtained even in close contact with the carrier of the pathogen, who is not aware of its presence.

The bacteria multiplies at high speed, and, according to statistics, more than 60% of people suffer from inflammatory processes of the stomach caused by this pathogen. With growth and development, a pathogen destroys the cell layer of the gastric and duodenal mucosa. As a result, harmful substances are released that cause inflammatory processes and ulcers in the digestive organs, which can lead to cancer.

Moreover, with its activity, the pathogen may not show its presence for a long time, while the disease will develop. The first alarming symptoms will manifest themselves as a large amount of toxins accumulate, in the form of:

  • frequent nausea or vomiting associated with eating,
  • pain in the gastrointestinal tract,
  • diarrhea, constipation,
  • problems with the assimilation of meat products.

The onset of symptoms and their severity depend on the state of the immune system, the presence of stress, concomitant diseases and bad habits. In all patients, in different ways and at different times. Such manifestations indicate chronic gastritis, and most often it is at this stage that patients seek qualified help. And then the appointment of FGDS with a biopsy becomes one of the first and important points in the diagnosis of the disease.

Helicobacter biopsy - the first step to healing

There are enough ways to detect this pathogen in modern medicine, but conducting a study using the method of taking a sample of the gastric mucosa, that is, a biopsy, allows you to get the most reliable picture, even with the recognition of the stages of the disease. And in a short time, which speeds up the process of diagnosis and the appointment of appropriate treatment.

  1. Before starting the procedure, the doctor processes the pharynx of the subject with a local anesthetic to avoid discomfort.
  2. Then a probe is inserted into the cavity of the stomach with a built-in light bulb at the end.
  3. A specialist examines the cavity of the diagnosed organs and splits off a piece of tissue for analysis.
  4. A tissue sample is laid out on a glass slide with urea. Interacting with Helicobacter, urea disintegrates and changes in color, which confirms the presence of this pathogen.

The result of FGDS of the stomach with the intake of tissue material in most cases is the most accurate. However, there are factors that adversely affect both the procedure and the analysis data. For example, taking antibiotics will distort the results. To avoid such troubles, you should stop taking medications before the start of the study.

When preparing for a Helicobacter biopsy, the following rules must be observed:

  1. Before the study, you should refrain from smoking for two hours.
  2. It is forbidden to eat food before diagnosis for 12 hours.
  3. Drink as little liquid as possible, and 2 hours before the start of the procedure, completely stop taking the liquid.

It is known from practice that smoking just one cigarette leads to a complication of the study: the gag reflex intensifies, more mucus forms in the stomach, which slows down the process of taking tests.

The diagnosis itself to detect the presence of Helicobacter passes only 15-20 minutes. But for the patient, the examination can turn into stress. Therefore, it is necessary that it was carried out by a professional who clearly knows all the subtleties of analysis. Having processed the results, it will be easy for a competent doctor to choose the necessary therapy, taking into account all the features of the disease.

Despite the fact that many methods are now proposed for identifying Helicobacter pylori, which cause less discomfort when taking materials for analysis, it is still better for the patient to play it safe, undergo a biopsy and get a reliable result.

Watch the video: Helicobacter pylori: An Update on Diagnostic Testing Hot Topic (January 2020).