Evaluation of Various Tests for Diagnosis of Helicobacter pylori Infection Among Patients with Dyspepsia in a Tertiary Care Institute of North India

Background: Helicobacter pylori infection is responsible for a wide spectrum of diseases, including gastritis, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue lymphoma.It can be diagnosed by various invasive and noninvasive techniques.Aims and objectives: The present study aims at simplifying the selection of routine diagnostic tests in a developing economy like India for patients with H. pylori-associated dyspepsia, considering various parameters.Materials and methods: A prospective study was conducted in the Department of Microbiology, Medicine, and Pathology over a period of 1 year.Upper gastrointestinal endoscopy was performed in enrolled patients after obtaining written informed consent.Culture and/or histopathological examination (HPE) findings were accepted as the gold standard.Results from bacteriological microscopic examination, rapid urease test (RUT), and stool antigen test (SAT) were then compared with it.Data were expressed as percentages and proportions.A Chi-square test was used to validate results.Results: Culture and HPE were the most specific tests with 100% specificity and positive predictive values (PPVs).Maximum sensitivity was observed with RUT (100%) followed by SAT (94.4%).RUT was least specific (90.6%).The PPV of the SAT was 94.4% with accuracy equivalent to that of HPE (96%).Conclusion: The SAT, being a simple and cost-effective noninvasive test with good sensitivity, accuracy, and PPV, can be considered a better alternative to invasive tests for diagnosing H. pylori infection in patients who do not require endoscopy.However, when endoscopy is specifically indicated, HPE and culture serve as an accurate and specific test, while SAT is still beneficial as a supplementary test for rapid screening.