The validation of the Helicobacter pylori CagA typing by immunohistochemistry: nationwide application in Indonesia

Muhammad Miftahussurur, Dalla Doohan, Ari Fahrial Syam, Iswan Abbas Nusi, Langgeng Agung Waskito, Kartika Afrida Fauzia, Yudith Annisa Ayu Rezkitha, Astri Dewayani, Reny I'tishom, Hasan Maulahela, Tomohisa Uchida, Yoshio Yamaoka

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2 Citations (Scopus)


We aimed to validate 2 types of antibodies, anti-CagA antibody and anti-East Asian CagA specific antibody (α-EAS antibody) for the determination of CagA status in Indonesia. We also confirmed the performance of α-EAS antibody for the detection of East Asian-type CagA H. pylori. Immunohistochemistry was performed using anti-CagA antibody and α-EAS antibody on gastric biopsy specimens from a total of 967 Indonesian patients. Diagnostic values of immunohistochemistry were evaluated with PCR-based sequencing as gold standard. Anti-CagA antibody had high sensitivity, specificity, and accuracy (87.0 %, 100 %, and 98.8 %, respectively) for determining CagA status. The α-EAS antibody was not suitable for the purpose of CagA status determination, as it had a low sensitivity (23.9 %). High specificity (97.6 %) but low sensitivity (41.2 %) and accuracy (66.3 %) was observed in α-EAS antibody to detect East Asian-type CagA. Patients with positive result of immunohistochemistry using anti-CagA antibody had significantly higher monocyte infiltration score in antrum (P < 0.001) and corpus (P = 0.009). In conclusion, the anti-CagA antibody is still suitable to be used in Indonesia for determining the CagA status, whilst the α-EAS antibody was not appropriate to discriminate between East Asian-type and non-East Asian-type CagA in Indonesia.

Original languageEnglish
Article number151594
JournalActa Histochemica
Issue number6
Publication statusPublished - Sept 2020


  • anti-CagA antibody
  • Anti-East Asian CagA antibody
  • CagA typing
  • Immunohistochemistry
  • Infectious disease


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