Pre-formed urease activity of Helicobacter pylori as determined by a viable cell count technique--clinical implications

A study to detect Helicobacter pylori in adenotonsillar tissue

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.

A better method for confirming Helicobacter pylori infection in Mongolian gerbils

BACKGROUND

Our aim was to evaluate the accuracy of the stool antigen test and the optimal time point for detecting Helicobacter pylori infection in a Mongolian gerbil model.

METHODS

We inoculated 8-week-old Mongolian gerbils with H. pylori (Vac A (+)/CagA(+)). The gerbil-infected model was developed as follows: H. pylori was put into broth (about 10(9) CFU/ml), and 50 gerbils were then fed with 1 ml intragastrically twice within a 3-day interval. Another ten gerbils were fed broth only. Twenty-six weeks after the inoculation, the gerbils were killed. The gastric mucosa was sampled for a series of examinations including culture, histology, rapid urease test, and polymerase chain reaction. Stool samples for a stool antigen test, H. pylori-specific stool antigen assay (HpSA), were collected during weeks 4, 6, 8, 12, and 26 after inoculation. Of the 50 gerbils inoculated with H. pylori, the inoculation was successful in 88%. Severe active gastritis, ulceration, and intestinal metaplasia were obvious.

RESULTS

The HpSA test results were sensitivity, 88.6%; specificity, 100%; positive predictive value (PPV), 100%; negative predictive value (NPV), 54.5%, and accuracy, 90%. The HpSA test began to be more sensitive and accurate (P < 0.05) beginning during week 6 after inoculation. We also found that H. pylori could be detected earlier and more easily in the group with high H. pylori density.

CONCLUSIONS

HpSA seems to be suitable for confirming colonization of gerbils with H. pylori. The optimal testing time point is around 6 weeks after inoculation. This test is a good choice for long-term observation of H. pylori infection in Mongolian gerbils.

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Accurate diagnosis of Helicobacter pylori. Urease tests

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.

Quantitative analysis of Helicobacter pylori infection in a mouse model

Progress in elucidating the pathogenesis of Helicobacter pylori gastric infection and in developing an H. pylori vaccine will be aided by an animal model in which H. pylori can be reliably detected. To validate the use of the mouse model of H. pylori infection, we determined the susceptibility of three inbred strains of mice (C57BL/6J, C57BL/10J and BALB/c) to two VacA+/CagA+ isolates of H. pylori (SPM326 and M1.16) and determined the effectiveness of microbiological, histological and molecular assays for H. pylori detection. For the detection of H. pylori in inoculated mice, reverse transcriptase-polymerase chain reaction was the most sensitive assay (82%), histological evaluation the next most sensitive (66%) and microbiological evaluation the least sensitive (38%); the assays were equally specific (100%). Of the two H. pylori isolates, M1.16 showed the highest rate of colonization, but SPM326 displayed the highest rate of persistent infection. Among the three mouse strains, C57BL/6J mice showed the highest level of both susceptibility to colonization and persistent infection. Anti-H. pylori antibody responses were induced in all inoculated mice and persisted for up to 8 weeks after H. pylori clearance. These results indicate that inbred mice experimentally infected with H. pylori is a reliable model for human infection, but host susceptibility to colonization and persistence of infection are dependent on the H. pylori isolate and the mouse strain.

Coexistence of Helicobacter pylori spiral and coccoid forms in experimental mice

AIM: To infect mice with Helicobacter pylori and detect immune response against two form of H. pylori.

METHODS: An isolate of H. pylori obtained from a patient with gastric cancer was used to infect mice. Fifty mice were divided into eight groups. Two groups served as negative control without any inoculation and internal negative control with 0.5 M NaHCO₃ and brain heart infusion (HBI), respectively. Mice in each experimental group were first inoculated with 0.5 M NaHCO₃ and then H. pylori suspension for 3 times at a 2-d interval. Mice from controls and infectious groups were sacrificed at a weekly interval postinfection. Gastric samples were trimmed, inoculated onto chocolate blood agar and then incujbated in microaerophilic atmosphere at 37¡æ for 14 d. Sera were examined for immunoglobulins against H. pylori spiral and coccoid antigens by ELISA.

RESULTS: After inoculation H. pylori was isolated in one mouse from one week postinfection. No H. pylori was detected in control mice. However, urease test was positive in 50% (5/10) control mice, 70% (7/10) mice inoculated with NaHCO₃ and BHI and 77% (23/30) mice infected with H. pylori. The systemic immune responses of the mice to H. pylori strain were determined by ELISA. The mice showed immune responses to both H. pylori spiral and coccoid antigens one week after infection with H. pylori. The peak mean absorbances of antibodies against spiral and coccoid forms were four weeks postinfection which showed 6 and 18 times higher than that of negative control group respectively (P < 0.01).

CONCLUSION: Spiral and coccoid forms of H. pylori coexist in experimental mice studied.

Culture of Helicobacter pylori from gastric biopsies transported in biopsy urease test tubes

Gastric biopsy specimens of 57 consecutively observed dyspeptic patients were studied for the presence of Helicobacter pylori by histological examination, biopsy urease test (BUT) and culture. For culture, biopsy samples were transported in both Stuart media and BUT tubes. All 15 isolates could be cultured from both Stuart and BUT tubes. Thus, if the main reason for culture of Helicobacter pylori is for antimicrobial susceptibility testing, only positive BUT tubes need to be submitted. This would reduce both the expense and the number of biopsies needed.

A sensitive and specific PCR method to detect Helicobacter felis in a conventional mouse model

Although many detection methods have been used to determine Helicobacter colonization in small animal models, the sensitivity and specificity of these detection methods are limited. To improve the Helicobacter felis conventional mouse model for accurate evaluation of therapeutic regimens, we developed a PCR for detection of, and a competitive PCR for quantitation of, H. felis in viral antibody-free (VAF) mice. The PCR was based on the H. felis 16S rRNA gene. An internal control DNA was used for competitive quantitation of the PCR. VAF conventional Swiss-Webster mice were infected with an H. felis culture by oral gavage. At various times after H. felis challenge and therapy, stomach mucosa was collected and evaluated by PCR. PCR detected approximately 50 to 100 H. felis cells per mouse stomach and showed no cross-reaction with other bacteria commonly found in mouse stomachs. Colonization of H. felis in the mouse stomach was confirmed by culture isolation from germfree mice and histological examination of VAF mice. Response to therapy in this H. felis model correlated well with results seen in human clinical trials with H. pylori. A model utilizing PCR detection which may be useful for discovering new antibiotics and/or vaccines against Helicobacter ulcer disease has been developed.

PCR detection of colonization by Helicobacter pylori in conventional, euthymic mice based on the 16S ribosomal gene sequence

Many animal models of Helicobacter infection have been described, including infection in rhesus monkeys, ferrets, gnotobiotic piglets, and mice. These animal models utilize a combination of detection methods, including culture, urease testing, and histopathology, all of which may be unreliable, insensitive, or labor-intensive. Development of new animal models of Helicobacter pylori requires new methods of detection with increased sensitivity and specificity. We have developed sensitive and specific PCR primers based on the 16S ribosomal gene sequence of H. pylori. The primers detected single-copy 16S DNA representing 0.2 cell of pure H. pylori (2 cells in the presence of mouse stomach mucosal DNA) and did not cross-react with closely related bacteria. We were able to detect colonization by H. pylori in conventional, euthymic, outbred mice up to 4 weeks postinoculation with a high percentage of isolates tested. One isolate of H. pylori was detected by PCR in 100% of the mice at 6 months and 60% of the mice 1 year after inoculation. Approximately 10(3) to 10(4) H. pylori cells per stomach were detected by utilizing this PCR methodology semiquantitatively. These primers and PCR methodology have facilitated detection of H. pylori colonization in conventional, euthymic mice, colonization which may not have been detectable by other methods.

Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection

BACKGROUND & AIMS

Multiple tests are available for determining Helicobacter pylori infection. Our aim was to compare the sensitivity, specificity, and negative and positive predictive value of the most widely available tests for diagnosis of H. pylori.

METHODS

A total of 268 patients (mean age, 53.7 +/- 15.8 years; 142 male and 126 female; 125 white and 143 nonwhite) was tested for H. pylori infection by [13C]urea breath test (UBT), measurement of serum immunoglobulin (Ig) G and IgA antibody levels, and antral biopsy specimens for CLO test, histology, and Warthin-Starry stain. No patient received specific treatment for H. pylori before testing. The infection status for each patient was established by a concordance of test results.

RESULTS

Warthin-Starry staining had the best sensitivity and specificity, although CLO test, UBT, and IgG levels were not statistically different in determining the correct diagnosis. The absence of chronic antral inflammation was the best method to exclude infection. Stratification of results by clinical characteristics showed that UBT and chronic inflammation were the best predictors of H. pylori status in patients older than 60 years of age. IgA was a better predictor in white patients.

CONCLUSIONS

The noninvasive UBT and IgG serology test are as accurate in predicting H. pylori status in untreated patients as the invasive tests of CLO and Warthin-Starry.

Recrudescence of Helicobacter pylori after apparently successful eradication: novel application of randomly amplified polymorphic DNA fingerprinting

The aim of this study was to find out if reinfection or recrudescence accounted for the recurrence of Helicobacter pylori infections after apparent eradication of the bacterium. Three hundred and twenty patients were treated with colloidal bismuth subcitrate (120 mg four times daily for four weeks), metronidazole and tetracycline (400 mg and 500 mg, respectively, thrice daily for the first week). H pylori was eradicated four weeks after the end of treatment as assessed by the rapid urease test, histological examination, Gram staining, and culture. However, the infection recurred in 29 (9.1%) of the patients one year after apparent eradication. Pre and posteradication isolates from five patients were available. DNA was extracted and used for restriction endonuclease analysis with Hind III and Hae III, and for polymerase chain reaction (PCR) based randomly amplified polymorphic DNA fingerprinting with a combination of two 10 nucleotide primers. Sodium dodecyl sulphate polyacrylamide gel electrophoretic analysis was performed also. Randomly amplified polymorphic DNA fingerprinting was unique in that it yielded highly discriminatory fingerprints, which showed that the pretreatment and recurrent isolates obtained from each of the five patients were indistinguishable from one another. This shows that recurrence of H pylori infection is probably caused by recrudescence and that the discriminatory power of randomly amplified polymorphic DNA fingerprinting is a practicable and discriminatory typing scheme for H pylori.