Comparison of culture, Real-time-PCR, ELISA, and histopathological examination methods for identification of Helicobacter pylori

Introduction: There are several methods used for the diagnosis of Helicobacter pylori infections, and there is an increasing demand for the use of non-invasive, more rapid tests. The aim of the present study was to compare different diagnostic methods. Methods: A total of 87 patients who had undergone esophagogastro-duodenoscopy were included in the study. Biopsy samples obtained from these patients were used for culture, real-time polymerase chain reaction (RT-PCR), and histopathological examination. Stool samples were also collected from these patients and were tested using the Helicobacter pylori stool antigen (HpSA) kit. Histopathological examination was accepted as the gold standard test. Results: H. pylori was identified by histological examination in 77/87 (87.5%) patients, whereas it was negative in 10/87 (12.5%) patients. Furthermore, positive results were obtained in 55 (63.2%), 71 (81.6%), and 77 (87.5%) patients using the culture method, HpSA analysis, and RT-PCR method, respectively. The sensitivity and specificity of culture, HpSA, and PCR tests were determined as 71.4% and 100%, 87% and 60%, and 97.4% and 80%, respectively. Antibiotic susceptibility tests were performed on 48 out of the 55 culture positive samples. Resistance to clarithromycin was found in 28 (58.3%), metronidazole in 14 (29.2%), and levofloxacin in 4 (8.3%) of the isolates. Resistance to amoxicillin and tetracycline was not observed. Conclusion: There are currently several invasive and non-invasive diagnostic tests for the detection of H. pylori infections. Each test has some advantages and disadvantages. The diagnostic method of choice should be easy and applicable to all age groups.