Accuracy of IgG Serology and Other Tests in Confirming Helicobacter pylori Eradication

Abstract

Background: In this study we assessed the accuracy of IgG serology and other tests in confirming Helicobacter pylori eradication. Methods: The outcome of anti-H. pylori therapy was established by at least two of the following tests: rapid urease test (RUT), culture, ¹⁴C urea breath test (non-capsule or capsule UBT), and IgG serology (Orion Diagnostica Pyloriset New EIA-G). Results: Successful H. pylori eradication was confirmed in 698 of 794 patients (88%). The percentage decrease in IgG antibody titre was related to the patients' pre-treatment IgG titre and time interval after treatment. A decrease in IgG titres of 40% or more confirmed H. pylori eradication with 100% specificity, whereas the sensitivity was 82%, 90%, 98%, and 98% 3, 4, 5, and 6 months after therapy, respectively. The 40% cut-off confirmed eradication 3 to 6 months after therapy in 328 of 339 patients (97%) with pre-treatment IgG titres of >700, in 36 of 45 patients (80%) with pre-treatment titres of 300-700, and in 5 of 12 patients (42%) with pre-treatment titres of <300. The sensitivity and specificity of the other tests 2 months after treatment were as follows: RUT, 84% and 100%; culture, 88% and 100%; non-capsule UBT, 100% and 89%; and capsule UBT, 100% and 97%. Conclusion: A decrease in IgG antibody titre of 40% or more 3 to 6 months after therapy and the capsule ¹⁴C UBT at the 2-month follow-up were both highly accurate in confirming H. pylori eradication.