Diagnostic Accuracy of Stool Antigen Test and Urea Breath Test Compared with Histopathology for Detection of Helicobacter pylori Infection Among Dyspeptic Patients: A Descriptive Cross-Sectional Study in A Tertiary Care Hospital

Abstract

Introduction: Helicobacter pylori infection is strongly associated with chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric malignancy. Accurate diagnosis is important for appropriate treatment and prevention of complications.

Aims: To evaluate the diagnostic accuracy of the stool antigen test and urea breath test compared with histopathology for the detection of Helicobacter pylori infection among dyspeptic patients and to determine the prevalence of infection in the study population.

Methods:This cross-sectional study was conducted at Nepalgunj Medical College Teaching Hospital from January 2025 to June 2025 using consecutive sampling to enroll 411 dyspeptic patients fulfilling inclusion criteria. Clinical assessment, stool antigen testing, urea breath testing, upper gastrointestinal endoscopy, rapid urease testing, and histopathological examination were performed. Histopathology served as the reference standard. Data were collected using structured and semi-structured proforma including demographic details, clinical findings, endoscopic findings, and laboratory investigations. Informed written consent was obtained from all participants. Statistical analysis included calculation of sensitivity, specificity, positive predictive value, negative predictive value, and Cohen’s kappa agreement statistics.

Results: Among the participants, 231 were male with majority from Banke district (28.22%). Histopathology confirmed Helicobacter pylori infection in 171 (41.61%) patients. Stool antigen test was positive in 168 (40.88%) patients while urea breath test was positive in 176 (42.82%) patients. Endoscopic gastritis was observed in 196 (47.69%) patients, erosive gastritis in 82 (19.95%), and peptic ulcer disease in 49 (11.92%). Urea breath test demonstrated slightly higher sensitivity compared to stool antigen testing.

Conclusion: The prevalence of Helicobacter pylori infection among dyspeptic patients was high. Both stool antigen test and urea breath test demonstrated good diagnostic performance. These findings support the use of non-invasive diagnostic methods in resource-limited settings.