Synonym

• H. pylori antibody titers

Tubes

• Red, tiger top, or gel barrier tube
• 1-5 mL of venous blood

Additional information

• Handle sample gently to prevent hemolysis
• Send sample to lab immediately

Info

• Helicobacter pylori antibody titer testing is a measure of H. pylori-specific IgG antibodies in the blood
• Helicobacter pylori, previously known as Campylobacter pylori, is a gram-negative microaerophilic bacillus infecting only gastric-type mucosal tissue
• Sites of infection may also extend to the esophagus and/or duodenum
• Infected individuals develop measurable antibody response with elevated specific IgG and IgA in serum and secretory IgA and IgM in the stomach
• H. pylori infection is usually acquired in childhood or early adulthood by ingesting contaminated food and water and through person to person contact, and is most often asymptomatic
• Approximately 50% of the world's population is infected. However, only 10% of infected individuals develop ulcers and 1% develop gastric cancers

Clinical

• The indications for Helicobacter pylori antibody titers, include:
• As a screening test for possible H. pylori infection in persons with gastrointestinal symptoms
• Aids in differentiating H. pylori infection from other causes of primary and secondary peptic ulcers
• May be used as part of the evaluation of gastritis, gastric carcinoma, or peptic or duodenal ulcer
• Assists in differentiating dyspepsia caused by H. pylori from other causes
• H. pylori IgG antibody levels can be used to monitor the success of antibiotic treatment for this infection
• A person without any gastrointestinal symptoms having evidence of the presence of H. pylori is said to be colonized rather than infected. Thus, the basis for clinical diagnosis should not be based on serology alone, but rather on a combination of serology (and breath or stool tests), symptoms, and gastric biopsy-based tests
• The advantages of this test include:
• Noninvasive screening procedure
• Can be done as both qualitative (rapid results) and quantitative assay
• >90% of infected individuals exhibit immunoglobulin G (IgG) antibodies that can be detected for up to 1 year after treatment

Additional information

• The sensitivity for this test is 94% with a specificity of 78%, compared with biopsy, an invasive procedure for which the sensitivity is 93% and specificity 99%
• The limitations of this test include
• IgG levels fall by 1 year after successful treatment so cannot be used to monitor for past infection (treated)
• 7% of the infected individuals may not exhibit IgG antibodies
• Other organisms may cause cross-reactivity
• False negatives occur in elderly or immunocompromised patients
• Ideally, pre- and post-treatment sera should be assayed simultaneously for optimal diagnostic accuracy
• CagA IgG ELISA test detects IgG antibodies by recognizing the protein product of the cytotoxin associated gene A
• Other tests to detect and/or confirm H. pylori infection include:
• Endoscopic gastric biopsy
• Urea breath hydrogen test from exhaled breath
• Stool antigen test
• Related laboratory tests include:
• Gastric acid stimulation
• Gastrin

Nl Result

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

• Method: Enzyme-linked immunosorbent assay (ELISA)
• Normal: Negative
• The result reported and titer listed below applies to IgG, IgM and IgA antibodies from the blood

High Result

Conditions associated with positive H. pylori titers include:

• Past or present infection with H. pylori
• Gastritis - chronic or chronic active
• Duodenal ulcers (95-98%)
• Gastric ulcers (60-90%)
• Gastric adenocarcinoma
• Gastric lymphoma

References

• Dore MP et al. Immunity markers in patients with Helicobacter pylori infection: effect of eradication. Helicobacter. 2005 Oct;10(5):391-7.
• eMedicine from WebMD®. Helicobacter Pylori Infection. [Homepage on the Internet] ©1996-2007. Last updated on October 12, 2006. Last accessed on July 25, 2007. Available at URL: http://www.emedicine.com/med/topic962.htm
• Galadari IH et al. The role of Helicobacter pylori in urticaria and atopic dermatitis. Skinmed. 2006 Jul-Aug;5(4):172-6.
• Koskenpato J et al. Helicobacter pylori and different topographic types of gastritis: treatment response after successful eradication therapy in functional dyspepsia. Scand J Gastroenterol. 2002 Jul;37(7):778-84.
• Laboratory Corporation of America. Helicobacter pylori Antibodies, IgG. [Homepage on the internet]© 2007. Last updated on September 25, 2006. Last accessed on July 25, 2007. Available at URL: http://www.labcorp.com/datasets/labcorp/html/chapter/mono/se022700.htm
• LabTestsOnline®. Helicobacter pylori. [Homepage on the Internet]© 2001-2007. Last reviewed on June 24, 2005. Last accessed on July 25, 2007. Available at URL: http://www.labtestsonline.org/understanding/analytes/h_pylori/sample.html
• Okan A et al. Relationship between non-steroidal anti-inflammatory drug use and Helicobacter pylori infection in bleeding or uncomplicated peptic ulcers: A case-control study. J Gastroenterol Hepatol 2003 Jan;18(1):18-25.
• Tanaka E et al. Prevalence of Helicobacter pylori infection and risk of upper gastrointestinal ulcer in patients with rheumatoid arthritis in Japan. Mod Rheumatol. 2005 Oct;15(5):340-5.
• Triantafillidis JK et al. Relation between Helicobacter pylori infection, thyroid hormone levels and cardiovascular risk factors on blood donors. Hepatogastroenterology. 2003 Dec;50 Suppl 2:cccxviii-cccxx.