Diagnostic Accuracy of Stool Antigen and Serological Tests for Helicobacter pylori Infection in Symptomatic Patients at a Tertiary Care Hospital in Islamabad

Authors

  • Rumeela Iqbal Department of Medical Laboratory Technology, Al Nafees Medical College, Isra University, Islamabad, Pakistan.
  • Muhammad Ahmad Department of Medical Laboratory Technology, Al Nafees Medical College, Isra University, Islamabad, Pakistan.
  • Muhammad Bilal Department of Medical Laboratory Technology, Al Nafees Medical College, Isra University, Islamabad, Pakistan.
  • Shahzeera Begum Department of Medical Laboratory Technology, Al Nafees Medical College, Isra University, Islamabad, Pakistan.
  • Maryam Khalid Department of Medical Laboratory Technology, Al Nafees Medical College, Isra University, Islamabad, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v4i2.2911

Keywords:

Helicobacter pylori, Immunochromatographic Test (ICT), Blood Antibody Test, Stool Antigen Test, Gastrointestinal Infections, Diagnostics Accuracy, Resource-Limited Settings.

Abstract

Introduction: Helicobacter pylori is a gram-negative bacterium linked to chronic gastritis, peptic ulcer disease, and gastric cancer, with a high burden in developing countries. In Pakistan, up to 70% of the population is affected due to poor sanitation, contaminated water, overcrowding, and low socioeconomic conditions. Both invasive and non-invasive methods are used to detect H. pylori, but invasive tests are costly and impractical, making non-invasive tests preferable for routine diagnosis. Blood antibody tests are easy to perform but cannot distinguish past from active infection, limiting their reliability. Stool antigen testing is a reliable non-invasive method for detecting active H. pylori infection and is suitable for resource-limited settings. Objectives: This study aimed to compare the diagnostic effectiveness of blood antibody testing and stool antigen testing for the detection of Helicobacter pylori infection among patients presenting with gastrointestinal symptoms., to determine the prevalence of Helicobacter pylori infection in relation to age and gender among the study population and to evaluate the suitability of stool antigen testing as a reliable method for diagnosing active Helicobacter pylori infection in routine clinical practice. Methodology: A comparative prospective study was conducted among 80 patients presenting gastrointestinal symptoms at Al-Nafees Medical College and Hospital, Islamabad, with the Serology Department of Nayab Labs & Diagnostic Center - Blue Area, Islamabad from September 2025 to December 2025. Participants were selected using non-probability convenience sampling based on the inclusion and exclusion criteria of this study. Blood and stool samples were collected and tested using commercially available ICT kits. Data were analyzed using SPSS version 27.0 and the McNemar test was applied to compare diagnostic test results of both blood and stool tests with a statistical significance set at p < 0.05. The study adhered to the ethical standards and informed consent was obtained from all participants. Results: The stool antigen test was positive in 68 patients (85%), and the blood antibody test was positive in 59 cases (73.75%) with a statistical significance of p < 0.03. The greater positivity rate on stool antigen testing points to the fact that the test has a better capability to identify active infection. It was found that the prevalence of infection was higher among the male participants than it was among the female participants and the age group of between 26-50 years reported the highest number of positive cases. A statistically significant difference was noted between the two diagnostic methods, favoring stool antigen testing. Conclusion: In conclusion, stool antigen testing was more effective than blood antibody testing for identifying of active H. pylori infection. According to our results, stool antigen testing should be preferred for routine diagnosis and as a clinical decision-making tool in symptomatic patients, especially in resource-limited settings.

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References

1. Siddique, A. R., Hossain, L., Rana, M. A., Banerjee, P. K., Rahman, A., Chowdhury, M. A., Sina, H., Yeasmin, S., & Siddique, A. T. (2020). Prevalence and association of Helicobacter pylori with gastro-duodenal mucosal lesions in patients with dyspepsia. Journal of Dhaka Medical College, 28(1), 100-104. https://doi.org/10.3329/jdmc.v28i1.45764

2. Sukthaworn, S., Moungthard, H., Sirisai, C., Anuponganan, W., Peerathippayamongkol, C., Mus-u-dee, M., & Taengchaiyaphum, S. (2024). Helicobacter pylori cytotoxin-associated gene a (cagA) and Vacuolating cytotoxin gene a (Vaca) genotypes in gastrointestinal patients from central Thailand. Cureus. https://doi.org/10.7759/cureus.64164

3. Ali, A., & AlHussaini, K. I. (2024). Helicobacter pylori: A contemporary perspective on pathogenesis, diagnosis and treatment strategies. Microorganisms, 12(1), 222. https://doi.org/10.3390/microorganisms12010222

4. Chen, Y., Malfertheiner, P., Yu, H., Kuo, C., Chang, Y., Meng, F., Wu, Y., Hsiao, J., Chen, M., Lin, K., Wu, C., Lin, J., O’Morain, C., Megraud, F., Lee, W., El-Omar, E. M., Wu, M., & Liou, J. (2024). Global prevalence of Helicobacter pylori infection and incidence of gastric cancer between 1980 and 2022. Gastroenterology, 166(4), 605-619. https://doi.org/10.1053/j.gastro.2023.12.022

5. HUSSAIN, T., KHAN, M. J., IQBAL, J., KHAN, Z., NAZ, A., & BILAL, M. PREVALENCE OF HELICOBACTER PYLORI IN HUMAN POPULATION IN RURAL AND URBAN AREAS OF DISTRICT PESHAWAR, PAKISTAN. https://doi.org/10.17605/OSF.IO/GPU34

6. Duan, Y., Xu, Y., Dou, Y., & Xu, D. (2025). Helicobacter pylori and gastric cancer: Mechanisms and new perspectives. Journal of Hematology & Oncology, 18(1). https://doi.org/10.1186/s13045-024-01654-2

7. Duan, M., Li, Y., Liu, J., Zhang, W., Dong, Y., Han, Z., Wan, M., Lin, M., Lin, B., Kong, Q., Ding, Y., Yang, X., Zuo, X., & Li, Y. (2023). Transmission routes and patterns of helicobacter pylori. Helicobacter, 28(1). https://doi.org/10.1111/hel.12945

8. Ambe, L. A., Goretti, C. M., Vernyuy, L. M., Ambe, B. E., Tanwieh, E. R., Hodabalo, A., & Kwinji, B. T. (2025). PREVALENCE AND ASSOCIATED RISK FACTORS OF HELICOBACTER PYLORI INFECTION IN ASYMPTOMATIC AND SYMPTOMATIC PATIENTS ATTENDING THE NKWEN DISTRICT HOSPITAL BAMENDA. IRASS Journal of Applied Medical and Pharmaceutical Sciences, 2(3), 15-32. https://irasspublisher.com/assets/articles/1742728576.pdf

9. Ishikawa, E., Nakamura, M., Satou, A., Shimada, K., & Nakamura, S. (2022). Mucosa-associated lymphoid tissue (MALT) lymphoma in the gastrointestinal tract in the modern era. Cancers, 14(2), 446. https://doi.org/10.3390/cancers14020446

10. Hasanuzzaman, M., Bang, C. S., & Gong, E. J. (2024). Antibiotic resistance of Helicobacter pylori: Mechanisms and clinical implications. Journal of Korean Medical Science, 39(4). https://doi.org/10.3346/jkms.2024.39.e44

11. Schulz, C., Liou, J., Alboraie, M., Bornschein, J., Campos Nunez, C., Coelho, L. G., Quach, D. T., Fallone, C. A., Chen, Y., Gerhard, M., Gisbert, J. P., Jung, H., Katelaris, P. H., Kim, J. G., Lu, H., Macke, L., Mahachai, V., Moss, S. F., Remes Troche, J. M., … Malfertheiner, P. (2025). Helicobacter pylori antibiotic resistance: A global challenge in search of solutions. Gut, 74(10), 1561-1570. https://doi.org/10.1136/gutjnl-2025-335523

12. Shao, Y., Lin, Y., Fang, Z., Yan, J., Zheng, T., & Ye, G. (2024). Analysis of Helicobacter pylori resistance in patients with different gastric diseases. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-55589-2

13. Sukri, A., Hanafiah, A., Yusoff, H., Shamsul Nizam, N. A., Nameyrra, Z., Wong, Z., & Raja Ali, R. A. (2022). Multidrug-resistant Helicobacter pylori strains: A five-year surveillance study and its genome characteristics. Antibiotics, 11(10), 1391. https://doi.org/10.3390/antibiotics11101391

14. Siddiqui, T. R., Ahmed, W., Arif, A., Bibi, S., & Khan, A. (2016). Emerging trends of antimicrobial resistance in Helicobacter pylori isolates obtained from Pakistani patients: The need for consideration of amoxicillin and clarithromycin. J Pak Med Assoc, 66(6), 710-6.

15. Waqar, F., Noor, M., Haider, E., Farhat, K., Ali, S., & Fatime Gilani, S. F. (2024). Therapeutic efficacy and drug safety comparison of one-week Vonoprazan triple therapy with two-weeks Esomeprazole triple therapy in Helicobacter pylori infection: Findings from a single-centre randomized clinical trial in population of Pakistan. Journal of the Pakistan Medical Association, 74(4), 432-435. https://doi.org/10.47391/jpma.9545

16. Aumpan, N., Mahachai, V., & Vilaichone, R. (2022). Management of Helicobacter pylori infection. JGH Open, 7(1), 3-15. https://doi.org/10.1002/jgh3.12843

17. Liu, L., & Nahata, M. C. (2024). Newer therapies for refractory Helicobacter pylori infection in adults: A systematic review. Antibiotics, 13(10), 965. https://doi.org/10.3390/antibiotics13100965

18. Zhang, Y., Yan, Z., Jiao, Y., Feng, Y., Zhang, S., & Yang, A. (2025). Innate immunity in Helicobacter pylori infection and gastric oncogenesis. Helicobacter, 30(2). https://doi.org/10.1111/hel.70015

19. Borka Balas, R., Meliț, L. E., & Mărginean, C. O. (2022). Worldwide prevalence and risk factors of Helicobacter pylori infection in children. Children, 9(9), 1359. https://doi.org/10.3390/children9091359

20. Qiao, Y., Zhou, Y., Zhao, L., Yang, S., Zhang, X., & Liu, S. (2024). Sex differences in Helicobacter pylori infection and recurrence rate among 81,754 Chinese adults: A cross-sectional study. BMC Gastroenterology, 24(1). https://doi.org/10.1186/s12876-024-03404-7

21. Fakhry, M., Abdelazeem, K., Abdelmeguid, M. M., Abdelmaksoud, M. A., Abdelrazzak, E., Abdelmola, O. M., Salama, S., EL-Nasser, W. S., Mohamed, M., Younes, M. A., & Hassan, A. M. (2024). Comparative assessment of diagnostic accuracy: Helicobacter pylori stool antigen test versus rapid urease test in adult patients with upper gastrointestinal symptoms. Al-Azhar Assiut Medical Journal, 22(2), 110-117. https://doi.org/10.4103/azmj.azmj_34_24

22. Costa, L. C., Das Graças Carvalho, M., La Guárdia Custódio Pereira, A. C., Teixeira Neto, R. G., Andrade Figueiredo, L. C., & Barros-Pinheiro, M. (2024). Diagnostic methods for Helicobacter pylori. Medical Principles and Practice, 33(3), 173-184. https://doi.org/10.1159/000538349

23. Sonnenberg, A. (2022). Epidemiology of Helicobacter pylori. Alimentary Pharmacology & Therapeutics, 55(S1). https://doi.org/10.1111/apt.16592

24. Li, H., Shen, Y., Song, X., Tang, X., Hu, R., Marshall, B. J., Tang, H., & Benghezal, M. (2022). Need for standardization and harmonization of Helicobacter pylori antimicrobial susceptibility testing. Helicobacter, 27(2). https://doi.org/10.1111/hel.12873

25. Cardos, A. I., Maghiar, A., Zaha, D. C., Pop, O., Fritea, L., Miere (Groza), F., & Cavalu, S. (2022). Evolution of diagnostic methods for Helicobacter pylori infections: From traditional tests to high technology, advanced sensitivity and discrimination tools. Diagnostics, 12(2), 508. https://doi.org/10.3390/diagnostics12020508

26. Yang, H., & Hu, B. (2021). Diagnosis of Helicobacter pylori infection and recent advances. Diagnostics, 11(8), 1305. https://doi.org/10.3390/diagnostics11081305

27. Mujtaba, A., Ibrahim, M. S., Parveen, S., Sarwar, N., Alsagaby, S. A., Raza, M. A., Abdelgawad, M. A., Ghoneim, M. M., El‐Ghorab, A. H., Selim, S., Al Abdulmonem, W., Hussain, M., & Fenta Yehuala, T. (2025). Comparative analysis of diagnostic techniques for Helicobacter pylori infection: Insights for effective therapy. Journal of Cellular and Molecular Medicine, 29(6). https://doi.org/10.1111/jcmm.70487

28. Soomro RA, Kaleem M, Qazi RA, Irshad F, (2022). Zafar M. Significance of Various Diagnostic Methods for the Detection of Helicobacter Pylori Infection. Journal of Liaquat University of Medical & Health Sciences, 21(02):126-30. https://doi.org/10.22442/jlumhs.2022.00916

29. Zaman, M. A., Hashim, I., Iqbal, S., & Jameel, M. (2025). Prevalence of helicobacter-pylori associated gastritis among patients in Quetta district, Balochistan. Insights-Journal of Health and Rehabilitation, 3(3 (Health & Allied)), 502-508. https://doi.org/10.71000/qv3d7335

30. Bordin, D. S., Voynovan, I. N., Andreev, D. N., & Maev, I. V. (2021). Current Helicobacter pylori diagnostics. Diagnostics, 11(8), 1458. https://doi.org/10.3390/diagnostics11081458

31. Elbehiry, A., Marzouk, E., Aldubaib, M., Abalkhail, A., Anagreyyah, S., Anajirih, N., Almuzaini, A. M., Rawway, M., Alfadhel, A., Draz, A., & Abu-Okail, A. (2023). Helicobacter pylori infection: Current status and future prospects on diagnostic, therapeutic and control challenges. Antibiotics, 12(2), 191. https://doi.org/10.3390/antibiotics12020191

32. Qiu, E., Li, Z., & Han, S. (2021). Methods for detection of Helicobacter pylori from stool sample: Current options and developments. Brazilian Journal of Microbiology, 52(4), 2057-2062. https://doi.org/10.1007/s42770-021-00589-x

33. Kang, X., Gou, L., Chen, X., Wang, Y., Liu, Y., & Zhang, D. (2025). Application value and performance of stool antigen detection in the diagnosis of Helicobacter pylori infection. European Journal of Clinical Microbiology & Infectious Diseases, 45(1), 69-77. https://doi.org/10.1007/s10096-025-05281-8

34. Zeeshan M, Ahmad S, Aslam S, Shahid A, ul Ain N, Ramzan A, Syed A, Khalid T. Comparison Of Helicobacter. Pylori Diagnostic Tests In Tertiary Care Hospital, Mardan.

35. Ali, H., Ullah, M., Jamshaid, S., Hamza, Khan, H., Shehzad, B., & Ullah, I. (2025). Comparison of Helicobacter pylori antibody and antigen tests for diagnosing infection in symptomatic patients: A cross-sectional study from district Mardan. Journal of Health, Wellness and Community Research, e118. https://doi.org/10.61919/67thsb08

36. Khorsheed, S. A. (2024). A Comparative Study of Serological and Stool Antigen Tests for Helicobacter pylori Infection Diagnosis. J Angiother, 8(4):1-6. https://doi.org/10.25163/angiotherapy.849578

37. Saeed, J., Shafqat, F., Kashif, Z., Rehman, M., Malik, S. S., & Haseeb, A. (2022). Incidence of Helicobacter pylori infection among dyspeptic children and adults diagnosed through serum antibody and stool antigen tests considering histopathology as gold standard in Mayo hospital, Lahore Pakistan. Pakistan Journal of Medical and Health Sciences, 16(1), 247-249. https://doi.org/10.53350/pjmhs22161247

38. Qiao, Y., Zhou, Y., Zhao, L., Yang, S., Zhang, X., & Liu, S. (2024). Sex differences in Helicobacter pylori infection and recurrence rate among 81,754 Chinese adults: A cross-sectional study. BMC Gastroenterology, 24(1). https://doi.org/10.1186/s12876-024-03404-7

39. Shrestha, A. B., Pokharel, P., Sapkota, U. H., Shrestha, S., Mohamed, S. A., Khanal, S., Jha, S. K., Mohanty, A., Padhi, B. K., Asija, A., Sedhai, Y. R., Rijal, R., Singh, K., Chattu, V. K., Rodriguez-Morales, A. J., Barboza, J. J., & Sah, R. (2023). Drug resistance patterns of commonly used antibiotics for the treatment of Helicobacter pylori infection among South Asian countries: A systematic review and meta-analysis. Tropical Medicine and Infectious Disease, 8(3), 172. https://doi.org/10.3390/tropicalmed8030172

40. Ansari, S., & Yamaoka, Y. (2022). Helicobacter pylori infection, its laboratory diagnosis, and antimicrobial resistance: a perspective of clinical relevance. Clinical microbiology reviews, 35(3), e00258-21. https://journals.asm.org/doi/full/10.1128/cmr.00258-21

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Published

2026-02-28

Issue

Vol. 4 No. 2 (2026): Indus Journal of Bioscience Research

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Original Article

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How to Cite

Iqbal, R., Muhammad Ahmad, Muhammad Bilal, Begum, S., & Khalid, M. (2026). Diagnostic Accuracy of Stool Antigen and Serological Tests for Helicobacter pylori Infection in Symptomatic Patients at a Tertiary Care Hospital in Islamabad. Indus Journal of Bioscience Research, 4(2), 208-215. https://doi.org/10.70749/ijbr.v4i2.2911