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Test Code HPRP Helicobacter pylori with Clarithromycin Resistance Prediction, Molecular Detection, PCR, Tissue


Ordering Guidance


If testing directly from feces is desired, order HPFRP / Helicobacter pylori with Clarithromycin Resistance Prediction, Molecular Detection, PCR, Feces.

 

For more information see Helicobacter pylori Diagnostic Algorithm.



Specimen Required


The high sensitivity of amplification by polymerase chain reaction requires the specimen to be processed in an environment in which contamination of the specimen by Helicobacter pylori DNA is unlikely.

 

Submit only 1 of the following specimens:

 

Specimen Type: Fresh tissue or biopsy

Sources: Stomach (or duodenum)

Container/Tube: Sterile container

Specimen Volume: Entire collection or 5 mm (3) approximate size of a pencil eraser

Collection Instructions:

1. Collect fresh tissue specimen.

2. Submit tissue in a sterile container (without adding anything).

3. Refrigerate or freeze the specimen.

Specimen Stability Information: Refrigerated (preferred) 7 days/Frozen 7 days

 

Preferred:

Supplies: Tissue Block Container (T553)

Specimen Type: Formalin-fixed, paraffin-embedded (FFPE) tissue block

Sources: Stomach (or duodenum)

Container/Tube: Tissue block

Collection Instructions: Submit FFPE tissue block to be cut and returned.

Specimen Stability Information: Ambient (preferred)/Refrigerated

 

Acceptable:

Specimen Type: Formalin-fixed, paraffin-embedded (FFPE) tissue scroll

Sources: Stomach (or duodenum)

Container/Tube: Sterile container for each individual cut section (scroll)

Collection Instructions: Perform microtomy and prepare five separate 10-micron sections. Each section (scroll) must be placed in a separate sterile container for submission.

Specimen Stability Information: Ambient (preferred)/Refrigerated


Secondary ID

607595

Useful For

Aiding in the diagnosis of Helicobacter pylori infection and prediction of clarithromycin resistance or susceptibility directly from gastric biopsies

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
TISSR Tissue Processing No No

Testing Algorithm

When this test is ordered, the reflex test may be performed at an additional charge.

 

For more information see Helicobacter pylori Diagnostic Algorithm.

Method Name

Real-Time Polymerase Chain Reaction (PCR)

Specimen Type

Varies

Specimen Minimum Volume

Fresh tissue or biopsy: 5 mm(3)
Formalin-fixed paraffin-embedded tissue block: One block
Formalin-fixed paraffin-embedded tissue scroll: Two 10-micron sections

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Reject Due To

Tissue in formalin
formaldehyde, or acetone
FFPE slides
Reject

Reference Values

Not detected

Interpretation

A ‘detected’ result indicates the presence of Helicobacter pylori 23S ribosomal RNA gene; also indicated is whether or not one the three most common 23S ribosomal RNA gene mutations (A2143G, A2142G/C) associated with clarithromycin resistance is detected.

 

A ‘not detected’ result for H pylori indicates the absence of detectable H pylori DNA but does not negate the presence of the organism and may occur due to inhibition of the polymerase chain reaction (PCR), sequence variability underlying primers or probes, or the presence of H pylori DNA in quantities less than the limit of detection of the assay.

Method Description

Fresh tissue samples (approximately 2 x 2 x 5 mm) are placed in a polymerase chain reaction (PCR) Bead Tube containing Tris-EDTA buffer, and proteinase K and digested on the Bertin Precellys Disruptor. Formalin-fixed, paraffin-embedded (FFPE) tissue scrolls are placed in a PCR bead tube containing Tris-EDTA buffer and proteinase K and undergo a prolonged heat treatment for digestion. Once digested, samples undergo DNA extraction on a MagNA Pure 96 instrument. The PCR assay employs a target-specific detection system including primers as well TaqMan detection probes alongside a SimpleProbe for melt curve analysis-based genotyping targeting the 23S ribosomal RNA gene.

 

The LightCycler 480 II instrument is used to amplify and monitor target nucleic acid sequences by fluorescence during PCR cycling. Detection of amplified product is based on the TaqMan probe principle. For PCR product detection, the TaqMan probe binds the complementary strand of amplified target. Specific PCR Taq polymerase with 5'-3' exonuclease activity degrades the probe, releasing the fluorophore and breaking the proximity to the quencher molecule, allowing fluorescence of the fluorophores. At the conclusion of PCR cycling, amplified product is thermally denatured and then cooled to allow for a fluorescein labeled SimpleProbe to anneal to an 18-base pair region of the amplified target that includes 2 positions’ mutations which are known to confer clarithromycin resistance. The temperature is slowly raised, while consistently monitoring fluorescence. The process is completed in a closed system to mitigate contamination. Contamination control is enhanced using uracil -DNA glycosylase enzymatic treatment and a master mix which includes dUTPs.(Chen D, Cunningham SA, Cole NC, Kohner PC, Mandrekar JN, Patel R. Phenotypic and molecular antimicrobial susceptibility of Helicobacter pylori. Antimicrob Agents Chemother. 2017;61(4):e02530-16. doi: 10.1128/AAC.02530-16)

Day(s) Performed

Monday through Friday

Report Available

4 to 6 days

Specimen Retention Time

7 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

87798

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HPRP H pylori + Clarithro Resist, PCR 88509-5

 

Result ID Test Result Name Result LOINC Value
HPS3 Specimen Source 31208-2
616027 Helicobacter pylori Result 91060-4
616028 Clarithromycin Resistance Result 88509-5

Forms

If not ordering electronically, complete, print, and send Gastroenterology and Hepatology Test Request (T728) with the specimen.