51
|
Marshall BJ, Seow CH, Levitt MD. Use of a Minnesota tube to tamponade bleeding from an ileorectal anastomosis. ANZ J Surg 2007; 77:916-7. [PMID: 17803569 DOI: 10.1111/j.1445-2197.2007.04277.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
52
|
Windsor HM, Abioye-Kuteyi EA, Marshall BJ. Methodology and transport medium for collection of Helicobacter pylori on a string test in remote locations. Helicobacter 2005; 10:630-4. [PMID: 16302991 DOI: 10.1111/j.1523-5378.2005.00355.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Helicobacter pylori can be isolated from patients using the string test but contaminating oral and nasopharyngeal microflora need to be suppressed by rapid plating out onto selective culture media. Recently, use of this diagnostic method was enhanced by using a novel transport medium to collect specimens from subjects in a remote Australian clinic over 1300 km from the laboratory. METHODS Retrieved string tests were transported to the laboratory in chilled polystyrene boxes in 5 ml screw-cap bottles with 3 ml of a brain heart infusion broth plus antibiotics. These were 20 g/ml vancomycin, 10 g/ml trimethoprim, 10 g/ml cefsulodin, and 10 g/ml amphotericin B. A comparison was made between subjects who gargled with a chlorhexidine mouthwash before swallowing the string test and those who did not. RESULTS Forty-five urea breath test-positive subjects were tested and H. pylori was isolated from 34 of them. Successful culture was achieved from string tests that were in transit for up to 29 hours and where the maximum temperature in the transport box was 14 degrees C. The additional use of a mouthwash had a marked effect on the isolation rate. H. pylori was cultured from 75% of subjects who gargled but only from 39% who did not. CONCLUSIONS This methodology and transport medium can broaden the use of the string test to more remote geographic areas where endoscopy is not feasible so that H. pylori isolates may still be obtained for diagnostic and epidemiologic studies. The value of this promising methodology of collection and transport should be assessed in a controlled study.
Collapse
|
53
|
Marshall BJ. The Lasker Awards: celebrating scientific discovery. JAMA 2005; 294:1420-1. [PMID: 16174708 DOI: 10.1001/jama.294.11.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
54
|
Marshall BJ, Windsor HM. Prevalence of Helicobacter pylori in Indigenous Western Australians: comparison between urban and remote rural populations. Med J Aust 2005. [DOI: 10.5694/j.1326-5377.2005.tb00027.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
55
|
Viiala CH, Windsor HM, Marshall BJ. Cure rate of high dose omeprazole and amoxicillin therapy for treatment-resistant Helicobacter pylori infection. J Gastroenterol Hepatol 2005; 20:663-4. [PMID: 15836727 DOI: 10.1111/j.1440-1746.2005.03833.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
56
|
Lloyd AL, Marshall BJ, Mee BJ. Identifying cloned Helicobacter pylori promoters by primer extension using a FAM-labelled primer and GeneScan analysis. J Microbiol Methods 2005; 60:291-8. [PMID: 15649531 DOI: 10.1016/j.mimet.2004.10.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 09/08/2004] [Accepted: 10/05/2004] [Indexed: 10/26/2022]
Abstract
The transcriptional start sites of 27 promoters in Helicobacter pylori strain 4187E have been successfully identified using a non-radioactive primer extension protocol. The technique involves reverse transcribing mRNA with a sequence-specific FAM-labelled primer. The length of the FAM-labelled cDNA primer extension product can be analysed on a standard DNA sequencer using GeneScan software. This information can be used in conjunction with DNA sequencing data to identify the transcriptional start site of a promoter. Total bacterial RNA produced more specific primer extension products with stronger FAM signals than a population enriched for mRNA. Using this technology, it is not necessary to complete the DNA sequencing reactions in parallel with the primer extension experiments. The FAM-labelled primer extension products do not require a PCR amplification step prior to analysis on a sequencing gel, and no phenol/chloroform purifications are required at any stage of the procedure. Fluorescent-based primer extension methods have obvious advantages over the conventional radioactive protocols, and this report extends the currently used methodologies in this field.
Collapse
MESH Headings
- Base Sequence
- Cloning, Molecular
- DNA Primers/genetics
- DNA, Bacterial/chemistry
- DNA, Bacterial/genetics
- Electrophoresis, Polyacrylamide Gel
- Fluoresceins/chemistry
- Genetic Techniques
- Helicobacter pylori/genetics
- Humans
- Molecular Sequence Data
- Promoter Regions, Genetic/genetics
- RNA, Bacterial/chemistry
- RNA, Bacterial/genetics
- RNA, Messenger/chemistry
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Analysis, DNA
- Transcription, Genetic/genetics
Collapse
|
57
|
Windsor HM, Morrow SD, Marshall BJ, Abioye‐Kuteyi EA, Leber JM, Bulsara MK. Prevalence of Helicobacter pylori in Indigenous Western Australians: comparison between urban and remote rural populations. Med J Aust 2005. [DOI: 10.5694/j.1326-5377.2005.tb06668.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
58
|
Windsor HM, Abioye-Kuteyi EA, Leber JM, Morrow SD, Bulsara MK, Marshall BJ. Prevalence of Helicobacter pylori in Indigenous Western Australians: comparison between urban and remote rural populations. Med J Aust 2005; 182:210-3. [PMID: 15748129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 12/14/2004] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To determine and compare the prevalence of Helicobacter pylori in an urban and a remote rural Western Australian Indigenous community. DESIGN Cross-sectional study of Helicobacter pylori status determined by urea breath tests between mid-January 2003 and the end of June 2004. PARTICIPANTS 520 self-selected fasting participants, comprising 270 members of the Martu community at Jigalong, Punmu and Parnngurr in the East Pilbara region (129 men, 141 women; age range, 2-90 years) and 250 people from the Perth Indigenous community (96 men, 154 women; age range, 3-75 years. RESULTS The overall prevalence of H. pylori was 76%, but the prevalence in the remote rural community was 91%, compared with 60% in the urban community. The odds of having H. pylori were six times greater for rural than for urban participants (odds ratio [OR], 6.34; 95% CI, 3.89-10.33). Further, the overall odds of H. pylori infection in males (rural and urban combined) were greater than for females (OR, 1.61; 95% CI, 1.02-2.54). In both communities, the prevalence of infection remained relatively constant after the age of 10. CONCLUSIONS The prevalence of H. pylori in the two Indigenous communities was two to three times higher than that in the non-Indigenous Australian population and higher than that shown in previous studies in Indigenous Australians.
Collapse
|
59
|
Marshall BJ, Windsor HM. The relation of Helicobacter pylori to gastric adenocarcinoma and lymphoma: pathophysiology, epidemiology, screening, clinical presentation, treatment, and prevention. Med Clin North Am 2005; 89:313-44, viii. [PMID: 15656929 DOI: 10.1016/j.mcna.2004.09.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Helicobacter pylori infection may be the most common chronic bacterial infection worldwide; however, the prevalence varies between countries and is usually linked to socioeconomic conditions. Gastric cancer is one of the most frequent cancers in developing countries and usually about the seventh most common in developed countries. This article explores the relation of H. pylori to gastric adenocarcinoma and lymphoma. The pathophysiology, epidemiology, screening, clinical presentation, treatment, and prevention are discussed.
Collapse
|
60
|
Pevey R, Miller LF, Marshall BJ, Townsend LW, Alvord B. Shielding for a cyclotron used for medical isotope production in China. RADIATION PROTECTION DOSIMETRY 2005; 115:415-9. [PMID: 16381758 DOI: 10.1093/rpd/nci206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Monte Carlo and discrete ordinate calculations have been performed to determine the doses at several locations in a positron emission tomography (PET) facility in China, where the radiation source is a cyclotron that is used for the production of the isotopes necessary for PET scans. The energy-dependent neutron source term is obtained by calculations using the ALICE code, and is interpolated for input to Monte Carlo and discrete ordinate calculations. The building that houses the cyclotron has a labyrinth of walls to minimise dose to operators and to other occupants of the building. Unbiased Monte Carlo calculations did not converge after more than one week of CPU time, whereas direction biasing alone resulted in convergence in several days. A study of several biasing techniques indicated that about a factor of 3 in computational efficiency is obtained using evaluated biasing methods. The use of adjoint fluxes for biasing Monte Carlo calculations can improve computational efficiencies by one or two orders of magnitude for some problems.
Collapse
|
61
|
Guttner Y, Windsor HM, Viiala CH, Dusci L, Marshall BJ. Nitazoxanide in treatment of Helicobacter pylori: a clinical and in vitro study. Antimicrob Agents Chemother 2004; 47:3780-3. [PMID: 14638482 PMCID: PMC296191 DOI: 10.1128/aac.47.12.3780-3783.2003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nitazoxanide (NTZ) is an antibiotic with microbiological characteristics similar to those of metronidazole but without an apparent problem of resistance. The aim of this study was the prospective evaluation of NTZ given as a single agent in the treatment of Helicobacter pylori infection. Twenty culture-positive patients with dyspepsia who had previously failed at least one course of H. pylori eradication therapy were enrolled. Subjects received 1 g of NTZ twice daily for 10 days. The safety and tolerability of the drug were assessed by physical examination, monitoring of adverse events, and clinical laboratory evaluation. Urea breath tests (UBTs) were performed 6 weeks posttreatment. H. pylori was isolated from UBT-positive patients by the string test or endoscopy with biopsy, and the MICs for these isolates were compared to those for isolates obtained pretherapy. The levels of tizoxanide, the active deacylated derivative of NTZ, were measured in blood, saliva, and tissue from two patients during treatment. The UBT results were positive for all 20 patients after completion of NTZ therapy. The MIC results demonstrated that the NTZ susceptibilities of none of the strains isolated from the patients posttherapy had changed significantly. No major adverse reactions were observed, but frequent minor side effects were observed. In conclusion, NTZ did not eradicate H. pylori when it was given as a single agent.
Collapse
|
62
|
Marshall BJ, Bulsara M. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health 2003; 39:568. [PMID: 12969219 DOI: 10.1046/j.1440-1754.2003.00222.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
63
|
Guttner Y, Windsor HM, Viiala CH, Marshall BJ. Human recombinant lactoferrin is ineffective in the treatment of human Helicobacter pylori infection. Aliment Pharmacol Ther 2003; 17:125-9. [PMID: 12492741 DOI: 10.1046/j.1365-2036.2003.01395.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lactoferrin, a multifunctional glycoprotein, is known to have anti-microbial actions. Bovine lactoferrin and recombinant human lactoferrin have been shown to inhibit Helicobacter pylori, and more recently recombinant human lactoferrin was found to significantly increase the eradication rate of H. pylori when added to standard triple therapy. AIM To determine the efficacy, safety and tolerability of recombinant human lactoferrin as a therapy in suppressing or eliminating H. pylori infection in subjects with minimal upper gastrointestinal symptoms who have not previously been treated. SUBJECTS AND METHODS Nine healthy subjects with minimal upper gastrointestinal symptoms and a positive urea breath test were recruited. None of the volunteers had previously been treated for H. pylori. Subjects received 5 x 1.0 g human recombinant lactoferrin daily for 5 or 14 days. Breath tests were repeated during therapy and shortly after to check for eradication. The safety and tolerability of the drug were assessed by physical examination, by monitoring adverse events, and clinical laboratory evaluation. RESULTS No conversion of the urea breath test from positive to negative was observed and there was no consistent change in urea breath test count to indicate a possible suppression of H. pylori. CONCLUSION Lactoferrin, given as a single agent, does not eradicate H. pylori infection.
Collapse
|
64
|
Viiala CH, Windsor HM, Forbes GM, Chairman SO, Marshall BJ, Mollison LC. Evaluation of a new formulation CLOtest. J Gastroenterol Hepatol 2002; 17:127-30. [PMID: 11966940 DOI: 10.1046/j.1440-1746.2002.02563.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The CLOtest and other rapid urease detection kits are widely used in the endoscopic diagnosis of Helicobacter pylori. A new formulation CLOtest has been developed with the goal of obtaining a positive result more rapidly. The aims of this study were to validate the sensitivity and specificity of the new test and compare the time taken for a positive result to be visible in both the new and standard CLOtest. METHODS Patients presenting for endoscopy at three Western Australian hospitals were prospectively enrolled. Gastric mucosal biopsies were obtained for the standard and new CLOtest and for histology. Grading of color change was conducted by staff blinded to the type of CLOtest used and conducted according to a standardized color chart. Helicobacter pylori status was defined by the combination of a positive standard CLOtest and histology, against which the new CLOtest was compared. Results were obtained at 1, 3 and 24 h, and at one center, at 10 min intervals for the first hour. RESULTS Three hundred and thirty-five patients were enrolled. Eighty-eight Helicobacter pylori-positive individuals were identified. At 24 h, the new test correctly identified all 88, with one false-positive result (sensitivity 100%, specificity 99.6%). At 1 h, sensitivity was 93% with a number of early false-positive results reducing specificity to 96%. Compared to the current CLOtest, the new formulation became positive faster at 20 min (P = 0.001, n = 51), but was similar at 1 h (P = 0.06, n = 88) and equivalent at 3 h. CONCLUSIONS The new formulation CLOtest is sensitive and specific, with a trend to give early positive results more quickly, although accuracy at 3 and 24 h is the same.
Collapse
|
65
|
Ho GY, Windsor HM, Snowball B, Marshall BJ. Helicobacter pylori is not the cause of sudden infant death syndrome (SIDS). Am J Gastroenterol 2001; 96:3288-94. [PMID: 11774938 DOI: 10.1111/j.1572-0241.2001.05327.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The cause of sudden infant death syndrome (SIDS) is unknown, but our previous hypothesis proposed that Helicobacter pylori could be a causative organism. In this study, we aimed to test this hypothesis by examining gastric and tracheal tissues from a prospective cohort of SIDS infants and re-examining previously studied paraffin-fixed tissues for H. pylori. METHODS Fresh gastric antral and trachea specimens obtained at postmortem from nine consecutive new cases of SIDS in Perth, Western Australia were studied prospectively. Tissues were evaluated for H. pylori by rapid urease test (CLOtest), bacterial culture, histology (hematoxylin and eosin, Warthin-Starry Silver, and immmunoperoxidase staining), and polymerase chain reaction (PCR). The latter two tests were also used for the re-examination of paraffin-embedded specimens from infants who died from SIDS (n = 17) and other non-SIDS causes (n = 7) in Kansas City, Missouri. RESULTS Specimens from nine consecutive SIDS infants in Western Australia showed no evidence of H. pylori by any analyses. In the paraffin-embedded gastric and trachea specimens from Missouri, rod and coccoid-shaped bacteria were seen histologically in 33.3% of the specimens, but these were not typical H. pylori. Upon analysis by PCR, "H. pylori DNA" was detected in 53% (9/17) of SIDS samples versus 57% (4/7) in non-SIDS samples. In all cases the immunoperoxidase stain was negative, suggesting that PCR either 1) gave false positive results in this type of potentially contaminated postmortem specimen or 2) H. pylori DNA was indeed present but not increased in prevalence in SIDS infants. CONCLUSIONS H. pylori is unlikely to be an etiological agent in SIDS.
Collapse
|
66
|
|
67
|
Abstract
Because of their ease of use, rapidity, and cost-effectiveness, rapid urease biopsy tests continue to be an important diagnostic tool for the endoscopist. Various forms of these tests are available in different parts of the world, characteristically leading to sensitivities of 93% to 97% and specificities of 98%. When performing rapid urease tests, the endoscopist should be aware of factors that might lead to false-negative and false-positive results and should ensure that the biopsy specimens are of adequate size and taken from the correct location.
Collapse
|
68
|
Mégraud F, Marshall BJ. How to treat Helicobacter pylori. First-line, second-line, and future therapies. Gastroenterol Clin North Am 2000; 29:759-73, vii. [PMID: 11190062 DOI: 10.1016/s0889-8553(05)70145-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Numerous trials were performed in the 1990s to define the optimal therapy for Helicobacter pylori infections. The proposed proton-pump inhibitor (PPI)-based and ranitidine bismuth citrate (RBC)-based triple therapies led to satisfactory results. Their first drawback is cost, and, for this reason, many people worldwide cannot benefit from these regimens. Failures of first-line therapies essentially are because of antimicrobial resistance, which increases with the selection pressure resulting from the use of these drugs. Second-line treatments using antimicrobial agents for which H. pylori resistance is low or nonexistent are being tested to find alternatives to the quadruple therapy. There is a need for new drugs, which should be highly effective, nonselective of resistant strains, and without side effects, to improve current regimens. These drugs may be the results of postgenomic studies.
Collapse
|
69
|
Abstract
Serologic testing is a useful noninvasive testing strategy for H. pylori. It is particularly useful in areas where the prevalence of H. pylori is high and inexpensive point-of-contact fingerprick tests are used. Sensitive tests are valuable ways of excluding H. pylori infection and can be used in conjunction with a direct test (urease histology culture or breath test) to confirm absence of H. pylori if the two methods are concordant. Serologic testing is more definitive and differentiating if the antigenic epitopes of H. pylori can be differentiated based on the antigenic epitopes that specifically associate with gastric cancer, peptic ulcer, and nonulcer dyspepsia. A study by Kawahara's group reported that Hsp 60 may be involved in the development of mucosa-associated lymphoid tissue based on ELISA. The idea of differentiating antigens for H. pylori may open a new area for use of serologic testing in the diagnostic approach of H. pylori infections.
Collapse
|
70
|
Abstract
Helicobacter pylori infection is the cause of chronic gastritis that progresses to atrophic gastritis over years and decades in more than half of affected individuals. H. pylori gastritis and, particularly, subsequent atrophic gastritis increase the risk for gastric cancer on multifactorial basis. Largely unknown cascades of manifold reactions result in gene errors of epithelial cells in gastric and atrophic stomach, which raise the likelihood of gastric neoplasias and cancer among people infected by H. pylori. The prevalences and incidences of gastric cancer and H. pylori are similarly decreased during the past decades in western countries, supporting the view that H. pylori infection is a key event and a trigger of the phenomena that result in cancer in some of the infected subjects.
Collapse
|
71
|
Marshall BJ, Sheehan MM, Northfield JR, Maher S, Carlisle R, Leger LH. School-based health promotion across Australia. THE JOURNAL OF SCHOOL HEALTH 2000; 70:251-252. [PMID: 10937375 DOI: 10.1111/j.1746-1561.2000.tb07430.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
72
|
Samuels AL, Windsor HM, Ho GY, Goodwin LD, Marshall BJ. Culture of Helicobacter pylori from a gastric string may be an alternative to endoscopic biopsy. J Clin Microbiol 2000; 38:2438-9. [PMID: 10835026 PMCID: PMC86836 DOI: 10.1128/jcm.38.6.2438-2439.2000] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Helicobacter pylori was isolated from a swallowed string from 32 of 33 adult subjects (97%) with selective culture media. With this method, antibiotic susceptibility testing and molecular epidemiology studies of H. pylori can be carried out without the need for the collection of specimens by endoscopic biopsy.
Collapse
|
73
|
Abstract
OBJECTIVE Culture of Helicobacter pylori (H. pylori) and the determination of its antibiotic susceptibility is of increasing importance with the rise in numbers of antibiotic-resistant strains. The aim of this study was to determine whether H. pylori could be successfully isolated from antral biopsies used in Rapid Urease Tests (CLOtests) in clinical practice. METHODS Antral biopsies from patients undergoing endoscopy were inserted into the gel of CLOtests to determine the H. pylori status of the patients. If the CLOtest was positive at the end of the endoscopy session, it was kept at ambient temperature until processed. In the laboratory, biopsies were removed from the gel and cultured on selective and nonselective media. In an attempt to enhance the recovery rate of H. pylori, a subset of positive CLOtests were kept at 4 degrees C from the time that the color change was noted until the removal of the biopsy. RESULTS One hundred and forty-one positive CLOtests were studied at times between 1 h and 6 h postendoscopy. Culture success was 93% in the 1st hour but fell off sharply after 2 h (p < 0.001). Isolation was also improved if positive CLOtests were stored at 4 degrees C and plated out within 4 h (p < 0.001). CONCLUSIONS H. pylori can be successfully cultured from biopsies in CLOtests kept at room temperature within 2 h or within 4 h if kept at 4 degrees C. Thus the antral biopsy in the CLOtest can be usefully retrieved when, in the light of the CLOtest result, the physician wishes to obtain both culture and antibiotic sensitivity results.
Collapse
|
74
|
Marchildon P, Balaban DH, Sue M, Charles C, Doobay R, Passaretti N, Peacock J, Marshall BJ, Peura DA. Usefulness of serological IgG antibody determinations for confirming eradication of Helicobacter pylori infection. Am J Gastroenterol 1999; 94:2105-8. [PMID: 10445535 DOI: 10.1111/j.1572-0241.1999.01285.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Prior studies have suggested that IgG antibody titers may be useful to confirm successful treatment of Helicobacter pylori (H. pylori) infection. However, the diagnostic value of decreasing IgG titers is limited by the necessity to perform pre and posttreatment tests in parallel which requires stored sera. Our objective was to assess the accuracy of IgG antibody titers using the HM-CAP IgG EIA kit (Enteric Products) in monitoring treatment of H. pylori infection and to compare the relative accuracy of parallel versus serial determinations. METHODS The 14C urea breath test (UBT) was used to confirm H. pylori infection in 83 dyspeptic patients and eradication of the organism at 4 wk and 6 months posttreatment. IgG titers pretherapy and 6 months posttherapy were determined either serially (separate EIA plates) or in parallel (same EIA plate), and the relative percent decline in antibody titer was calculated. RESULTS When a decline of > or = 25% at 6 months was used as the cut-off for H. pylori eradication, mean sensitivities of serial and parallel determinations were 87.5% and 86.8%, respectively, and mean specificities of both were 100%. In 68 of 75 patients in whom the organism was eradicated, the mean decrease in IgG titer at 6 months was 41.1% for serial determinations and 41.5% for parallel determinations. CONCLUSIONS Serial or parallel IgG titers offer equivalent diagnostic accuracy for confirming H. pylori eradication after therapy. A > or = 25% decline in titer 6 months after therapy is a sensitive and specific marker for eradication of the infection. Serial evaluation of IgG titers does not require serum storage, and is a cost-effective and accurate alternative to the UBT or endoscopy-based methods.
Collapse
|
75
|
Graham DY, Rakel RE, Fendrick AM, Go MF, Marshall BJ, Peura DA, Scherger JE. Recognizing peptic ulcer disease. Keys to clinical and laboratory diagnosis. Postgrad Med 1999; 105:113-6, 121-3, 127-8 passim. [PMID: 10086037 DOI: 10.3810/pgm.1999.03.594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An algorithmic approach to evaluation of dyspepsia or abdominal discomfort begins with differentiation between peptic ulcer disease and gastroesophageal reflux disease as well as recognition of alarm signs and symptoms for gastric cancer, which are indications for early endoscopy. In the absence of alarm symptoms, most patients should undergo noninvasive testing for H pylori infection with a serologic, urea breath, or stool antigen test. Factors to consider in selection of appropriate testing include reliability, specificity, sensitivity, cost, and local access and expertise. As a general rule, physicians should choose a test that has the best accuracy for the level of testing expertise available. The basic principle underlying testing for H pylori is that patients should not undergo testing unless the physician is willing to treat on the basis of a positive test result. In patients who receive treatment, confirmation of cure is important for preventing further morbidity and reducing risk of transmission of infection.
Collapse
|