A CASE OF FALSE NEGATIVE RESULT OF THE CONTROL STOOL-TEST WITH THE PRESENCE OF ACTIVE FORMS OF HELICOBACTER PYLORI INFECTION ON GASTRIC LINING OF CHRONIC NONATROPHIC GASTRITIS IN PATIENT
Journal Title: Український журнал медицини, біології та спорту - Year 2017, Vol 3, Issue 1
Abstract
Qualitative diagnosis of Helicobacter Pylori (HP) infection has a great importance in determining the type of gastritis, but has its difficulties due to a great amount of factors influencing the quality of such widely used testing methods, such as a stool-test and breathing test, as well as the impact of long-term psycho – emotional stress on accuracy of determination of HP infection according to the level of immunoglobulins G with the immunofermental analysis (IFA). It is much more difficult to control the quality of eradication of HP infection considering the fact that high level of immunoglobulins in the blood of the patient can stay up to two years (immune «trail»), which excludes the application of the method of determination of HP infection by IFA during the control. From this perspective, the interesting case of false negative stool test in the presence of HP infection on gastric mucosa in 2 months after the end of the course of treatment. Patient (woman) K., 40 years old, asked for the examination and treatment of a doctor-gastroenterologist of the clinical department of basic research laboratory on chronic Helicobacter Pylori infection of the Petro Mohyla Black Sea National University about periodic dull pain in epigastria, feeling of heaviness after eating, constipation (2–3 days). In history, it was found that the first manifestations (epigastric pain) appeared when she was 37 years old against the background of stress associated with the death of his father. In further aggravations became regular every year and were seasonal (spring/autumn). As for the patient, a comprehensive survey was undertaken, which included: a step-by-step pH-metry on Chernobrovyi V.N. methodology esophagogastroduodenoscopy (EGDS) generally accepted testing methodology, on helicobacter (HP) infection (urease test and microscoping of impression smear), histological studies of the stomach mucosa, biopsy material for which was taken from the 4 topographical zones of the stomach (the middle third division of the antrum section and stomach body on big and small curvature), biochemical testing on HP infection using package developed by our «Gastroenterology screening for families», which included: stooltest, test level of antibodies (G) to HP infection and the level of natural killers (SR-16) in the blood, detailed blood analysis. When carrying out the pH measuring, acidity level before treatment was consistent with gipoacidity of moderate selective; when conducting the EGDS the patient was diagnosed chronic gastroduodenit, which was confirmed histologically. When testing the gastric mucosa on HP infection for topographical zones in antrum division of Helicobacter infection was not founded, in the body of the stomach mucosa and on big and small curvature of HP infection was detected at high concentrations (+++), and on small curvature it was founded the intracellular «depot» HP. When conducting primary stool test before treatment was obtained a positive result; level of antibodies (G) to HP infection in the blood was 152.6 IU/ml (<15-negative), the level of natural killers (SR-16) in the blood amounted to 23.5% (norm – 12–23%); cells/μl-688 (norm – 70–552). The patient passed the course of treatment in the clinic according to the place of residence of a doctorgastroenterologist generally accepted scheme for 2 weeks. In 2 months after the end of treatment the patient conducted independently the control stool test, which was negative. However, the patient remained a sense of heaviness in the stomach after eating and she repeatedly has been studied in a clinical laboratory. During the conducting of a repeated double-testing of the stomach mucosa in antrum division, as well as in the body of the stomach on small curvature HP-was detected at low concentrations (+) in the body of the stomach for large curvature-(++). This incident can be explained from the point of view of the impact of the concentration of active forms of HP infection on gastric mucosa and the methodology of conducting the control stool test. At low concentrations of active forms of HP infection reliability of stool test drops drastically, and holding it according to the method, which offers firm-manufacturer, makes it even more untrue. Therefore, in order to obtain reliable results during the control it is necessary to use our latest release of stool test, and stool test by itself conduct not only in 1 month after treatment, as the firm – manufacturer recommended but also in 6 and 12 months.
Authors and Affiliations
A. Avramenko, N. Tyshko, E. Marchenko
Keywords
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