Journal List > Korean J Gastroenterol > v.70(4) > 1007695

Kim, Lee, Kwon, Lee, Kim, Sung, Park, and Shim: Serological Changes after Equivocal Helicobacter pylori-serology Test Findings Dependent on Gastric Secreting Ability

Abstract

Background/Aims

The serum anti-Helicobacter pylori (H. pylori) immunoglobulin G (IgG) and serum pepsinogen (PG) assays are widely used to screen for gastric cancer. An equivocal serology test finding indicates IgG titer between the positive and negative test findings. This study aims to evaluate the long-term follow-up result after an equivocal test finding on the serum anti-H. pylori IgG assay.

Methods

Koreans aged 18 years or older with an equivocal serum anti-H. pylori IgG assay finding were included. Subjects were excluded if they did not undergo H. pylori serology test, serum PG assay, and upper gastrointestinal (UGI) endoscopy on the same day at our center. The annual test findings were followed-up using the same methods.

Results

Of the 7,178 subjects who underwent the serum assays and UGI endoscopy on the same day, 274 (3.8%) subjects showed an equivocal H. pylori serology test finding. Of the 98 subjects who were followed-up, 58 (59.2%) showed seropositive finding at the mean follow-up period of 30.6±12.4 months. Subjects with seroconversion showed a higher initial serum PG I (p=0.023) and PG II (p=0.036) levels than those without seroconversion.

Conclusions

An equivocal H. pylori serology test finding was not rare (3.8%) in Korean adults, and 60% of equivocal subjects showed seroconversion within 3 years. Higher seroconversion rates in subjects with high PG I and PG II levels suggest that intact gastric secreting ability plays a role in the survival of H. pylori. Therefore, equivocal subjects with increased serum PG levels should be considered as potential seropositive subjects.

Figures and Tables

Fig. 1

Flow of the study. Of the 7,178 included subjects, 274 (3.8%) showed an equivocal H. pylori serology test finding. Of the 98 subjects followed-up with an equivocal test finding, 58 (59.2%) showed seroconversion. H. pylori, Helicobacter pylori; IgG, immunoglobulin G.

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Table 1

Baseline Characteristics of the Followed-up Subjects with an Equivocal H. pylori Test Finding

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Values are presented as mean±standard deviation or n (%) unless otherwise indicated.

H. pylori, Helicobacter pylori.

ap-values show the differences between 58 subjects with seroconversion and 40 subjects without seroconversion. Continuous variables are shown as mean value±standard deviation using the Student's t-test. Categorical variables are shown in frequency (%) using the Chi-square test or Fisher's exact test; b≥15 drinks/week for men, ≥8 drinks/week for women.

Table 2

Initial and Follow-up Test Findings of Subjects according to the Follow-up Serum Anti-H. pylori IgG Test Finding

kjg-70-181-i002

Variables are shown as mean value±standard deviation using the Student's t-test.

H. pylori, Helicobacter pylori; IgG, immunoglobulin G; PG, pepsinogen.

ap-values indicate differences between the subjects with seroconversion and without seroconversion; bp-values indicate differences between the initial and follow-up test findings using the signed-rank test.

Table 3

Differences between Subjects with a Negative Test Finding and Those with an Equivocal Test Finding

kjg-70-181-i003

Values are presented as mean±standard deviation or n (%) unless otherwise indicated. Continuous variables are shown as mean value±standard deviation using the Student's t-test. Categorical variables are shown in frequency (%) using the Chi-square test or Fisher's exact test.

H. pylori, Helicobacter pylori; PG, pepsinogen.

Table 4

Findings of Subjects with a History of H. pylori Eradication

kjg-70-181-i004

Upward arrow (↑) indicates that there was a synchronous increase in serum PG I and PG II levels during the follow-up period, whereas downward (↓) indicates vice versa.

H. pylori, Helicobacter pylori; M, male; F, female; PG, pepsinogen.

aSix subjects showed seroconversion at the follow-up test, although the initial serum PG I and PG II levels were low. Most showed decreasing trends of serum PG levels at the follow-up tests, suggesting that seroconversion is related to slow IgG clearance at posteradication period; bThree subjects showed increasing trends of serum PG levels at the follow-up tests, suggesting that there is a reinfection or recrudescence in these subjects; cTwo subjects showed seroreversion despite their high initial serum PG levels. Decreasing trends of serum PG I and PG II levels in these subjects suggest that initial equivocal test findings in these subjects were due to the delayed seroreversion after eradication.

Notes

Financial support This study was supported by the Korean National Research Foundation (NRF 2016R1D1A1B02008937).

Conflict of interest None.

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