Clinical Value Of Helicobacter Pylori Stool Test In Patients With Upper Gastrointestinal Bleeding

Objective:Our aim was to analyze the effect of upper gastrointestinal bleeding on the results of Helicobacter pylori stool antigen test(HpSA),and to investigate the value of HpSA in the diagnosis of H.pylori in patients with upper gastrointestinal bleeding.Methods: 243 patients who came to our hospital due to gastrointestinal symptoms were selected as the subjects from April 2015 to May 2016.Everyone accepted the rapid urease test(RUT),HpSA and H.pylori-PCR detection.All test results were observed and recorded.The subjects were divided into two groups according to the upper gastrointestinal bleeding,which were upper gastrointestinal bleeding group and non-bleeding group.The results of RUT detection were used as the criteria for the diagnosis of H.pylori infection.We analyzed the clinical value of HpSA and PCR in two groups,and explored the effect of upper gastrointestinal bleeding on HpSA.Results: In non-bleeding group the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and accuracy of HpSA detection were 77.03%(57/74),97.06%(66/68),25.67,0.24 and 86.62%(123/142),respectively.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and accuracy of PCR detection in non-bleeding group were 72.97%(54/74),94.12%(64/68),12.17,0.29 and 83.10%(118/142),respectively.The consistency between HpSA and RUT is good,Kappa=0.73.In upper gastrointestinal bleeding group the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and accuracy of HpSA detection were 86.67%(52/60),95.12%(39/41),17.40,0.14 and 90.10%(91/101),respectively.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and accuracy of PCR detection in upper gastrointestinal bleeding group were 80.00%(48/60),97.56%(40/41),32.79,0.21 and 87.13%(88/101),respectively.The consistency between HpSA and RUT is good,Kappa=0.80.The receiver operating characteristic curve(ROC)were drawn according to the test results.The area under the curve(AUC)of HpSA was 0.870±0.032,and the AUC of PCR was 0.835±0.036 in the non-bleeding group.The AUC of HpSA was 0.909±0.032,and the AUC of PCR was 0.888±0.035 in upper gastrointestinal bleeding group.Conclusion: HpSA has high sensitivity,specificity and accuracy in diagnosis of H.pylori infection.It is non-invasive,painless,and suitable for patients who are unwilling or unable to perform RUT detection.HpSA is not affected by upper gastrointestinal bleeding.It is suitable for patients with upper gastrointestinal bleeding,which is an ideal alternative to invasive tests.