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Goday A, Bagán A, Casajoana A, Serra C, Pera M, Villatoro M, Legido T, Julià H, Climent E, Castañer O, Flores Le Roux JA, Olano M, Pedro-Botet J, Benaiges D. Effects of Preoperative Quadruple Therapy for Helicobacter pylori on Bariatric Surgery Metabolic Outcomes. Obes Surg 2024; 34:1196-1206. [PMID: 38400943 PMCID: PMC11026217 DOI: 10.1007/s11695-024-07091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE To assess the effects of Helicobacter pylori (HP) eradication with an omeprazole, clarithromycin, amoxicillin, and metronidazole (OCAM) regimen on the metabolic profile and weight loss 12 months after bariatric surgery (BS). METHODS Retrospective analysis of a prospective cohort of patients with morbid obesity undergoing BS. HP presence was tested preoperatively by gastric biopsy and treated with OCAM when positive. Short-term metabolic outcomes and weight loss were evaluated. RESULTS HP infection was detected in 75 (45.7%) of the 164 patients included. OCAM effectiveness was 90.1%. HP-negative patients had a greater reduction in glucose levels at 3 (-14.6 ± 27.5 mg/dL HP-treated vs -22.0 ± 37.1 mg/dL HP-negative, p=0.045) and 6 months (-13.7 ± 29.4 mg/dL HP-treated vs -26.4 ± 42.6 mg/dL HP-negative, p= 0.021) and greater total weight loss (%TWL) at 6 (28.7 ± 6.7% HP-treated vs 30.45 ± 6.48% HP-negative, p= 0.04) and 12 months (32.21 ± 8.11% HP-treated vs 35.14 ± 8.63% HP-negative, p= 0.023). CONCLUSIONS Preoperative treatment with OCAM has been associated to poorer glycemic and weight loss outcomes after BS. More research is needed on the influence of OCAM on gut microbiota, and in turn, the effect of the latter on metabolic and weight loss outcomes after BS.
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Affiliation(s)
- Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona. Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona- PRBB), 08003, Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Madrid, Spain
| | - Andrea Bagán
- Department of Medicine, Universitat Pompeu Fabra. Plaça de la Mercè, 10-12, E-08002, Barcelona, Spain
| | - Anna Casajoana
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca IMIM- Hospital del Mar, 08003, Barcelona, Spain
| | - Carme Serra
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
| | - Manuel Pera
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca IMIM- Hospital del Mar, 08003, Barcelona, Spain
| | - Montserrat Villatoro
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
| | - Teresa Legido
- Neuroscience Group, Hospital del Mar Medical Research Institute, 08003, Barcelona, Spain
| | - Helena Julià
- Department of Endocrinology and Nutrition, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, 08243, Barcelona, Spain
| | - Elisenda Climent
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona. Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona- PRBB), 08003, Barcelona, Spain
| | - Olga Castañer
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona. Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona- PRBB), 08003, Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Madrid, Spain
| | - Juana A Flores Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona. Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona- PRBB), 08003, Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra. Plaça de la Mercè, 10-12, E-08002, Barcelona, Spain
| | - Miguel Olano
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003, Barcelona, Spain.
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona. Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona- PRBB), 08003, Barcelona, Spain.
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Madrid, Spain.
- Consorci Sanitari de l'Alt Penedès i Garraf, 08720, Vilafranca del Penedès, Spain.
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Kato S, Shimizu T, Toyoda S, Gold BD, Ida S, Ishige T, Fujimura S, Kamiya S, Konno M, Kuwabara K, Ushijima K, Yoshimura N, Nakayama Y. The updated JSPGHAN guidelines for the management of Helicobacter pylori infection in childhood. Pediatr Int 2020; 62:1315-1331. [PMID: 32657507 PMCID: PMC7839701 DOI: 10.1111/ped.14388] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
The Japan Pediatric Helicobacter pylori Study Group published the first guidelines on childhood H. pylori infection in 1997. They were later revised by the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (JSPGHAN). The H. pylori eradication rates, when employing triple therapy with amoxicillin and clarithromycin, currently recommended as the first-line therapy of H. pylori infection in Japan, have substantially decreased, creating an important clinical problem worldwide. In Japanese adults, the "test-and-treat" strategy for H. pylori infection is under consideration as an approach for gastric cancer prevention. However, the combined North American and European pediatric guidelines have rejected such a strategy for asymptomatic children. As risk for gastric cancer development is high in Japan, determining whether the "test-and-treat" strategy can be recommended in children has become an urgent matter. Accordingly, the JSPGHAN has produced a second revision of the H. pylori guidelines, which includes discussion about the issues mentioned above. They consist of 19 clinical questions and 34 statements. An H. pylori culture from gastric biopsies is recommended, not only as a diagnostic test for active infection but for antimicrobial susceptibility testing to optimize eradication therapy. Based upon antimicrobial susceptibility testing of H. pylori strains (especially involving clarithromycin), an eradication regimen including use of the antibiotics to which H. pylori is susceptible is recommended as the first-line therapy against H. pylori-associated diseases. The guidelines recommend against a "test-and-treat" strategy for H. pylori infection for asymptomatic children to protect against the development of gastric cancer because there has been no evidence supporting this strategy.
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Affiliation(s)
- Seiichi Kato
- Kato Children’s ClinicNatoriJapan
- Department of Infectious diseasesKyorin University School of MedicineTokyoJapan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | | | | | - Shinobu Ida
- Department of Pediatric Gastroenterology and EndocrinologyOsaka Women’s and Children’s HospitalOsakaJapan
| | - Takashi Ishige
- Department of PediatricsGunma University Graduate School of MedicineMaebashiJapan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases & ChemotherapyTohoku Medical and Pharmaceutical University Graduate School of Pharmaceutical SciencesSendaiJapan
| | - Shigeru Kamiya
- Department of Infectious diseasesKyorin University School of MedicineTokyoJapan
| | - Mutsuko Konno
- Department of PediatricsSapporo Kosei General HospitalSapporoJapan
| | - Kentaro Kuwabara
- Department of PediatricsHiroshima City Hiroshima Citizens HospitalHiroshimaJapan
| | - Kosuke Ushijima
- Department of Pediatrics and Child HealthKurume University School of MedicineKurumeJapan
| | | | - Yoshiko Nakayama
- Department of PediatricsShinshu University School of MedicineMatsumotoJapan
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Niyasom C, Ngoenmak T, Uthaisangsook S. Endoscopic finding and treatment outcome of children with Helicobacter pylori infection in lower northern Thailand. ASIAN BIOMED 2019. [DOI: 10.1515/abm-2019-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Background
Helicobacter pylori infection is one of the predisposing factors for gastritis, peptic ulcer, and duodenal ulcer. Definite diagnosis of H. pylori infection is important in planning effective medical management. However, confirming the diagnosis through bacterial culture takes a number of days, and thus delays treatment.
Objectives
To examine endoscopic findings in children associated with chronic abdominal pain and H. pylori infection to aid in early diagnosis. We also evaluated treatment outcome of H. pylori infection.
Methods
A retrospective study was performed by reviewing the medical records of children under 15 years of age with chronic abdominal pain who underwent esophagogastroduodenoscopy (EGD) between 2011 and 2017. According to 2016 Joint ESPGHAN/NASPGHAN Guidelines, H. pylori infection was defined by positive tests for both histopathology test and rapid urease test (RUT). The EGD finding, RUT, histopathologic finding, and treatment outcome were recorded.
Results
Forty-eight children presented with chronic abdominal pain (male 47.9%, female 52.1%, mean age was 8.44 ± 2.97 years). Twelve children out of 48 had H. pylori infection (12/48, 25%). Eight among the 12 children had antral nodularity (8/12), wherein there was no antral nodularity in children without H. pylori infection (0/36). This difference was statistically significant (P < 0.001). Sensitivity and specificity of antral nodularity finding for H. pylori infection were 66.7% and 100%, respectively. Eradication of H. pylori infection with standard regimen improved the abdominal pain within 4 weeks.
Conclusion
The occurrence of antral nodularity in endoscopic finding was significantly associated with H. pylori infection. In addition, antral nodularity finding showed a good sensitivity and high specificity for the diagnosis of H. pylori infection.
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Affiliation(s)
- Chayakamon Niyasom
- Department of Pediatrics, Faculty of Medicine, Naresuan University , Phitsanulok 65000 , Thailand
| | - Thitima Ngoenmak
- Department of Pediatrics, Faculty of Medicine, Naresuan University , Phitsanulok 65000 , Thailand
| | - Suwannee Uthaisangsook
- Department of Pediatrics, Faculty of Medicine, Naresuan University , Phitsanulok 65000 , Thailand
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Best LMJ, Takwoingi Y, Siddique S, Selladurai A, Gandhi A, Low B, Yaghoobi M, Gurusamy KS. Non-invasive diagnostic tests for Helicobacter pylori infection. Cochrane Database Syst Rev 2018; 3:CD012080. [PMID: 29543326 PMCID: PMC6513531 DOI: 10.1002/14651858.cd012080.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as 13C or 14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions.
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Affiliation(s)
- Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
| | | | | | | | | | - Mohammad Yaghoobi
- McMaster University and McMaster University Health Sciences CentreDivision of Gastroenterology1200 Main Street WestHamiltonONCanada
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Can Helicobacter pylori Eradication Treatment Modify the Metabolic Response to Bariatric Surgery? Obes Surg 2018; 28:2386-2395. [DOI: 10.1007/s11695-018-3170-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Adu-Aryee NA, Aabakken L, Dedey F, Nsaful J, Kudzi W. Comparison of endoscopic based diagnosis with Helicobacter urease test for Helicobacter pylori infection. BMC Res Notes 2016; 9:421. [PMID: 27576901 PMCID: PMC5004304 DOI: 10.1186/s13104-016-2237-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/23/2016] [Indexed: 01/27/2023] Open
Abstract
Background Helicobacter pylori is an important risk factor for gastritis, peptic ulcers and gastric cancer. The prevalence in developed countries is lower than 40 % but higher than 80 % in some developing countries. It is 75 % in Ghana. The Helicobacter urease test (HUT) is performed at endoscopy and gives an accurate diagnosis. The HUT is not routinely done at our facility and presumption of H. pylori is made based on endoscopic findings and H. pylori eradication prescribed, as the incidence in the general population is presumed high. Is this endoscopic diagnosis sufficient for diagnosing and treating H. pylori? We aimed to assess the feasibility of an endoscopic based H. pylori diagnosis and its accuracy using a HUT as the gold standard in consecutive patients. Methods Seventy-six consecutive adult patients with dyspepsia were assessed by upper gastrointestinal endoscopy. A clinical diagnosis of H. pylori or not was made. Biopsy samples were collected for HUT. H. pylori was diagnosed if HUT was positive. The results were then compared. Results Median age of patients was 45.0 years. H. pylori prevalence detected by HUT was 51.3 % (95 % CI 40.0–63.0). Sensitivity of endoscopic diagnosis of H. pylori was 71.8 % (95 % CI 55.1–85.0) and specificity was 37.8 % (95 % CI 22.5–55.2). There was no association between clinical findings (73.7 %) and HUT (26.3 %) (OR = 0.80; [95 % CI 0.24–2.64], p = 0.682). There was also no association between endoscopic diagnosis (71.8 %) and HUT (28.2 %), (OR = 1.55; 95 % CI 0.59–4.06, p = 0.373). Conclusion Helicobacter pylori infection was not as high as that published in earlier reports. The endoscopic diagnosis alone is not sufficient to make a diagnosis of H. pylori.
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Affiliation(s)
- N A Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - L Aabakken
- Division of Gastroenterology, University of Oslo, Oslo, Norway
| | - F Dedey
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - J Nsaful
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - W Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana.
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Seo JH, Youn HS, Park JJ, Yeom JS, Park JS, Jun JS, Lim JY, Park CH, Woo HO, Ko GH, Baik SC, Lee WK, Cho MJ, Rhee KH. Influencing Factors to Results of the Urease Test: Age, Sampling Site, Histopathologic Findings, and Density of Helicobacter pylori. Pediatr Gastroenterol Hepatol Nutr 2013; 16:34-40. [PMID: 24010104 PMCID: PMC3746048 DOI: 10.5223/pghn.2013.16.1.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 11/13/2012] [Accepted: 11/30/2012] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We investigated the positivity rate and the time period to the positive color change of the urease test in children and adults and assessed the correlation of the urease test to histopathologic findings. METHODS From 1995 to 2000, endoscopic biopsies of the antrum and body were collected from 811 children and 224 adults and subjected to urease tests and histopathology. RESULTS The positivity rate of the urease test was 49.4% for 0-4 years, 48.4% for 5-9 years, 47.3% for 10-15 years, and 62.5% for 20-29 years in the antrum. The positivity rate was 85.1% in 0-4 years, 82.3% in 5-9 years, 74.7% in 10-15 years, and 74.1% in 20-29 years for the body. In the antrum, the highest positivity rate was <1 hour for the group aged 10-29 years and 6-24 hours in the group <10 years old (p<0.0001). In the body, the highest positivity rate was <1 hour in adults and 6-24 hours in children (p<0.0001). The proportions of the positive reactions within 1 hour were similar for the antrum and the body. In the cases of more severe chronic gastritis, active gastritis, and Helicobacter pylori infiltration, a positive urease test reaction occurred more quickly (p<0.0001). CONCLUSION There were significant differences in urease tests according to age and sampling site. The discrepancy between the antrum and the body was greater in younger children. These results might be related to the low density and patchy distribution of bacteria in children and in the body.
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Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics, Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Korea
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Lan HC, Chen TS, Li AFY, Chang FY, Lin HC. Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy. BMC Gastroenterol 2012; 12:182. [PMID: 23272897 PMCID: PMC3573986 DOI: 10.1186/1471-230x-12-182] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 12/13/2012] [Indexed: 02/07/2023] Open
Abstract
Background The best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. This study aimed to evaluate the site and sensitivity of biopsy-based tests in terms of degree of gastritis with atrophy. Methods One hundred and sixty-four (164) uninvestigated dyspepsia patients were enrolled. Biopsy-based tests (i.e., culture, histology Giemsa stain and rapid urease test) and non-invasive tests (anti-H. pylori IgG) were performed. The gold standard of H. pylori infection was defined according to previous criteria. The sensitivity, specificity, positive predictive rate and negative predictive rate of biopsy-based tests at the gastric antrum and body were calculated in terms of degree of gastritis with atrophy. Results The prevalence rate of H. pylori infection in the 164 patients was 63.4%. Gastritis with atrophy was significantly higher at the antrum than at the body (76% vs. 31%; p<0.001). The sensitivity of biopsy-based test decreased when the degree of gastritis with atrophy increased regardless of biopsy site (for normal, mild, moderate, and severe gastritis with atrophy, the sensitivity of histology Giemsa stain was 100%, 100%, 88%, and 66%, respectively, and 100%, 97%, 91%, and 66%, respectively, for rapid urease test). In moderate to severe antrum or body gastritis with atrophy, additional corpus biopsy resulted in increased sensitivity to 16.67% compare to single antrum biopsy. Conclusions In moderate to severe gastritis with atrophy, biopsy-based test should include the corpus for avoiding false negative results.
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Affiliation(s)
- Hung-Chieh Lan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, #201 Shih-Pai Road, Section 2, Taipei, Taiwan, ROC
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Abdulqawi K, El-Mahalaway AM, Abdelhameed A, Abdelwahab AA. Correlation of serum antibody titres with invasive methods for rapid detection of Helicobacter pylori infections in symptomatic children. Int J Exp Pathol 2012; 93:295-304. [PMID: 22804766 DOI: 10.1111/j.1365-2613.2012.00831.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Helicobacter pylori (H. pylori) is causally associated with peptic ulcer disease and gastric carcinoma. Typically, children get infected during the first decade of life, but diseases associated with H. pylori are seen mainly in adults. Multiple diagnostic methods are available for the detection of H. pylori infection. The aim of this study was to evaluate the correlation and diagnostic accuracy of three invasive methods [rapid urease test (RUT), histology and bacterial culture] and one non-invasive method (IgG serology) for diagnosis of H. pylori infection in a prospective cohort study conducted on 50 symptomatic children between two and eighteen years of age. Endoscopies with gastric biopsies were performed for RUT, culture and histopathological examination, respectively. IgG antibodies were measured in patient sera using a commercially available enzyme-linked immunosorbent assay (ELISA). RUT and positive H. pylori IgG antibodies were concordant in 88% (44/50) of patients. Both tests were negative in 32% (16/50), and both were positive in 56% (28/50). Disagreement occurred in 12% (6/50) of the patients: three of them (6%) had positive RUT and negative H. pylori IgG, and another three (6%) had negative RUT and positive H. pylori IgG. A combination of RUT with non-invasive serology constituted the optimum approach to the diagnosis of H. pylori infection in symptomatic children. The non-invasive serological test (ELISA) could not be used alone as the gold standard because it cannot distinguish between active and recently treated infection; and bacterial culture could not be used alone because of its low sensitivity.
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Affiliation(s)
- Khaled Abdulqawi
- Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt.
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Yantiss RK, Lamps LW. To stain or not to stain...That remains the question. Am J Clin Pathol 2012; 137:343-5. [PMID: 22338045 DOI: 10.1309/ajcpxc4k9iovuekt] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Abstract
When an endoscopy is performed, it now becomes easier to observe indirect evidence of the presence of a Helicobacter pylori infection, given the progress of new methods including magnifying narrow band imaging or confocal laser endomicroscopy. Out of the biopsy-based tests, the novel original method proposed concerned culture in a broth medium with or without antibiotics and ELISA detection of H. pylori. New stool antigen tests are still appearing with no major improvement in comparison with the monoclonal-based tests already on the market. The combination of pepsinogen detection to H. pylori serology is now more and more evaluated to detect preneoplastic lesions.
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Affiliation(s)
- Cliodna A M McNulty
- Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
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Abstract
This article reviewed the important publications on Helicobacter pylori research with children between April 2010 and March 2011. The most interesting studies in the last year lend further weight to the evidence for vertical transmission of H. pylori. The discovery of a potential role for jhp0562, the gene which encodes for the cell envelope protein glycosyltransferase, in the progression to peptic ulcer disease is also very interesting as it may provide a novel way to distinguish children at risk of peptic ulcer disease from those who are not, and so determine those who requires treatment to eradicate H. pylori. The rise in non-H. pylori-associated ulcers and erosions continues to be reported with no apparent risk factors for these ulcers identified to date. High levels of treatment failure continue to be reported, and there remains an urgent need for more effective treatment regimes for children.
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Affiliation(s)
- Josef Sýkora
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen, Czech Republic.
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