Utility of serology in determining Helicobacter pylori eradication after therapy.
OBJECTIVE
To determine the usefulness of four serological tests in confirming cure of H pylori infection before the previously reported six-month post-treatment delay.


METHODS
As part of a prospective, blinded, controlled trial, in which patients with duodenal ulcers were randomized to receive different combinations of antibiotics, serum samples were obtained in 89 patients before treatment, as well as on several occasions after treatment. Antibody titres were determined by ELISA with Bio-Rad immunoglobulin (Ig) A, Bio-Rad IgG, Pyloriset EIA-A for IgA and Pyloriset EIA-G for IgG. Eradication was confirmed with antral biopsy three months after therapy.


RESULTS
The percentage drop in titre following treatment was significantly larger for the group of patients who were treated successfully with all four kits. Optimal cut-offs for identifying successful therapy were determined, and accuracy improved as the interval between testing and therapy was prolonged. Six months after therapy, the IgG test from Bio-Rad achieved 100% sensitivity and 80% specificity, and that from Pyloriset achieved 88% sensitivity and 100% specificity. At three months, however, test performance was quite good, with 90% sensitivity and 80% specificity when using a Pyloriset IgA titre drop of 20% or greater to predict successful eradication.


CONCLUSIONS
Serology is a simple, easily available, noninvasive method that exhibits good positive predictive value in the confirmation of successful cure of H pylori infection three or six months after treatment.
Fallone
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CA
Division of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec. cfallone@medphys.mgh.mcgill.ca
Loo
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VG
Barkun
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AN
D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D000907:Antibodies, Bacterial / Q000097:blood*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D007124:Immunoenzyme Techniques; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D009942:Organometallic Compounds / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D009942:Organometallic Compounds; D008795:Metronidazole; D000658:Amoxicillin; C002791:bismuth tripotassium dicitrate