1995. Implementation of <i>Helicobacter pylori</i> Stool Antigen Testing in a Large Metropolitan Centre: A Prospective Comparative Diagnostic Trial
Bibliographic record
Abstract
Clinical guidelines for H. pylori screening and post-treatment testing endorse the use of urea breath test (UBT), H. pylori stool antigen test (HpSAT), and biopsy-related tests. Due to protracted wait times at our patient service centers and non-compliance in children and elderly with complications for the UBT, we sought to compare UBT and HpSAT in the city of Calgary, Canada with a population close to 1.4 million people. To achieve this, a prospective diagnostic trial was performed comparing UBT to HpSAT in patients presenting with dyspepsia. A total of N = 150 patients agreed to undergo UBT (13C-UBT kit, Helikit, Isodiagnostika Inc.) and consented to provide a stool specimen for simultaneous HpSAT testing (Diasorin LIAISON® XL H. pylori SA Monoclonal chemiluminescent immunoassay) in our centralized laboratory. Our data show that concordant results were obtained in 148/150 (98.7%) patients with a positivity rate of 17.4%. One of two discrepants (UBT positive/HpSAT negative) resolved after repeat testing. Using UBT as the gold standard, HpSAT had a sensitivity of 96.30% (95% CI; 81.03% to 99.91%) and specificity of 100% (95% CI; 97.05% to 100.00%). A positive predictive value of 100% and negative predictive value of 99.2% (95% CI; 94.73% to 99.88%) was obtained. For patients where drug information was available, 38/130 (29.2%) had received an antibiotic associated with H. pylori in the preceding 12 months, with UBT and HpSAT providing concordant results in 37/38 (97.4%) of these individuals. Of note, 6/130 (4.6%) patients had received a specific combination anti-H.pylori treatment, and all 6/6 (100%) had concordant negative results suggesting successful eradication. A post-implementation economic evaluation of labor and materials associated with testing demonstrates a cost-savings of approximately USD5.47 per specimen in this locale. Our study confirms that HpSAT is a viable alternative to UBT for H. pylori screening in our jurisdiction with equivalent test performance and cost-savings. Pre- and post-implementation analysis of test compliance rates, waiting times, and test turn around times will also be presented. D. Pillai, Diasorin: None, Educational grant.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".