Diagnosis of Helicobacter pylori Infection and Recent Advances

Abstract

Background: Helicobacter pylori (H. pylori) infects approximately 50% of the world population. Its infection is associated with gastropathies, extra-gastric digestive diseases, and diseases of other systems. There is a canonical process from acute-on-chronic inflammation, chronic atrophic gastritis (CAG), intestinal metaplasia (IM), dysplasia, and intraepithelial neoplasia, eventually to gastric cancer (GC). H. pylori eradication abolishes the inflammatory response and early treatment prevents the progression to preneoplastic lesions. Methods: the test-and-treat strategy, endoscopy-based strategy, and screen-and-treat strategy are recommended to prevent GC based on risk stratification, prevalence, and patients’ clinical manifestations and conditions. Challenges contain false-negative results, increasing antibiotic resistance, decreasing eradication rate, and poor retesting rate. Present diagnosis methods are mainly based on invasive endoscopy and noninvasive laboratory testing. Results: to improve the accuracy and effectiveness and reduce the missed diagnosis, some advances were achieved including newer imaging techniques (such as image-enhanced endoscopy (IEE), artificial intelligence (AI) technology, and quantitative real-time polymerase chain reaction (qPCR) and digital PCR (dPCR). Conclusion: in the article, we summarized the diagnosis methods of H. pylori infection and recent advances, further finding out the opportunities in challenges.

Diagnostic Accuracy of H. pylori Status by Conventional Endoscopy: Time-Trend Change After Eradication and Impact of Endoscopic Image Quality

“…In regions with limited resources, the most applicable approach using WLE would be to check for the history of H. pylori eradication and to assess the endoscopic findings of H. pylori infection and gastric atrophy. As H. pylori selferadication and reinfection are uncommon (25,26), endoscopic findings suggesting H. pylori infection in subjects with no history of eradication likely indicate current infection. Additional tests for H. pylori infection diagnosis and a mapping biopsy would be needed only in a few difficult situations.…”

“…First, the criteria for H. pylori current infection included positive antibody tests, which were not reliable markers of current infection. Although spontaneous eradication of H. pylori is rare (25,26) and the absence of a prior history of H. pylori eradication was required as a necessary criterion, the possibility of false-positive tests might not be accurately eliminated. Second, this is a single-center study with a limited number of assessors.…”

A prospective study for evaluating the effect of gastric targeted biopsy sampling with I‐scan optical enhancement on the diagnostic yield of CLOtest for Helicobacter pylori infection

“…I‐scan technology is a digital image‐enhanced endoscopy (IEE) technology from PENTAX Medical, based on postprocessing of reflected light with the difference of reflective properties between the normal and abnormal mucosa 18,20 . I‐scan OE is a newer technology that incorporates an additional optical filter, so it combines both digital enhancement (I‐scan) and optical enhancement (I‐scan OE).…”

“…It enhances the endoscopic detection, demarcation, and characterization of the mucosal and vascular patterns by providing a clear, enhanced image and detailed topography. It can detect more subtle mucosal abnormalities, 17,20 and it is easy to observe and assess the abnormal mucosa with the aid of I‐scan technology and gain more information from visual examination of the gastric mucosa than standard white light endoscopy (WLE) 18,19,21 . The nonmagnifying I‐scan exam provides better image quality of H. pylori gastritis 22 .…”

Gastric epithelial histology and precancerous conditions

“…H. pylori gastritis accounts for more than 80% of gastritis, and persistent infection may eventually cause chronic atrophic gastritis (CAG) through the canonical process originating from acute-on-chronic inflammation. H. pylori eradication abolishes the inflammatory response[ 12 ]. A noninvasive test-and-treat strategy is appropriate for uninvestigated dyspepsia[ 13 ].…”