Comparison of serum IgA and IgG antibodies for detecting Helicobacter pylori infection.
OBJECTIVE
Although the diagnostic utility of serum IgG antibodies to Helicobacter pylori (H. pylori) is well established, the usefulness of IgA-based tests is less well documented. The aim of this study was to evaluate two commercially available ELISAs, both for IgG and IgA.


METHODS
Rapid urease test and histology analysis were performed in 183 patients. A patient was considered to be H. pylori-positive when either biopsy test was positive, and considered to be noninfected when both tests were negative. Intestinal metaplasia was determined by dye endoscopy with methylene blue. ELISA testing was performed using the EPI HM-CAP IgG and PP-CAP IgA assays and EIAgen IgG and IgA assays.


RESULTS
Sensitivity was 94.7, 93.9, 94.8, and 97.0% for HM-CAP IgG, PP-CAP IgA, EIAgen IgG, and EIAgen IgA, respectively. Although sensitivity was excellent for both IgG and IgA antibodies, specificity of both IgA EIAs was low (PP-CAP 72.6%, EIAgen H. pylori IgA 59.2%). Three of 101 H. pylori-infected patients were PP-CAP positive and HM-CAP negative and four were EIAgen H. pylori IgA positive and EIAgen IgG negative. Of eight noninfected patients in whom intestinal metaplasia was found, PP-CAP IgA results were positive in three of five patients with a HM-CAP IgG negative result and EIAgen IgA was detected in one of four patients with an EIAgen IgG negative result.


CONCLUSIONS
Since some patients have IgA positive but IgG negative results, great care should be taken not to underestimate the prevalence of H. pylori infection from the results of IgG serology.
Urita
Yoshihisa
Y
Division of Gastroenterology and Hepatology, Toho University School of Medicine, Tokyo.
Hike
Kazuo
K
Torii
Naotaka
N
Kikuchi
Yoshinori
Y
Kurakata
Hidenori
H
Kanda
Eiko
E
Sasajima
Masahiko
M
Miki
Kazumasa
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000032:analysis / Q000097:blood*; D001707:Biopsy, Needle; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy / Q000379:methods; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology* / Q000302:isolation & purification*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis / Q000097:blood*; D007074:Immunoglobulin G / Q000032:analysis / Q000097:blood*; D007413:Intestinal Mucosa / Q000382:microbiology / Q000473:pathology; D007564:Japan; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000379:methods
D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G