While few new methods have been proposed for Helicobacter pylori diagnosis, there are still a number of articles evaluating the current methods and trying to improve their accuracy.
Invasive tests EndoscopyAttempts to diagnose Helicobacter pylori infection directly during endoscopy have been made in the past. While the observation of H. pylori per se is usually not possible, indirect evidence of its presence can be found. This year, using standard endoscopy in children, Hidaka et al. [1] were able to show that the absence of regular arrangement of collecting venules at two sites, indicated the absence of H. pylori infection with an excellent sensitivity (100%) and specificity (90%). The respective values for antral nodularity, the usual criterion, were 84% and 100%.Three studies evaluated narrow band imaging (NBI), a technique enhancing the mucosal and capillary patterns of the gastric surface. Three hundred patients were explored with conventional NBI and 5 mucosal patterns were identified, corresponding to different grades of histological gastritis [2]. Magnifying NBI was also used to investigate the changes in gastric mucosal patterns before and 12 weeks after H. pylori eradication. In patients without severe atrophy and intestinal metaplasia (IM), the changes in pit size and density of fine irregular vessels were observed with a perfect sensitivity and specificity. In contrast, no change occurred in patients with severe atrophy and IM, regardless of H. pylori eradication [3]. The authors emphasized that this method predicts histological conditions and pepsinogen levels and may be cost effective in gastric cancer surveillance [4].Confocal laser endomicroscopy, a magnifying endoscopy technique, allows an in depth analysis of the gastric mucosa. In a first study, Ji et al. [5] identified H. pylori gastritis with a 92% accuracy. The mean kappa value for inter-observer agreement was 0.78. In a second study, the same group focused on the severity of H. pylori-associated gastritis, especially atrophy and IM, with a rather good diagnostic accuracy [6].
HistologyThe ever well-known OLGA (Operative Link on Gastritis Assessment) staging system was highlighted again under the aspect of histology reporting of gastritis. It is especially valuable as it allows a prediction of the gastric cancer risk [7]. A long-term follow-up (12 years) of 93 patients confirmed that all invasive or intra-epithelial gastric neoplasia were consistently associated with high-risk (III ⁄ IV) OLGA stages [8].Immunohistochemistry can be used to assess the presence of H. pylori with more certainty. However, its systematic use in the routine of a pathology laboratory does not seem necessary because it is of no value in cases with an absence of pathological abnormality nor reactive gastropathy [6]. However, it allows the
AbstractWhen an endoscopy is performed, it now becomes easier to observe indirect evidence of the presence of a Helicobacter pylori infection, given the progress of new methods including magnifying narrow band imaging or confocal l...