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Ansari S, Yamaoka Y. Helicobacter pylori Infection, Its Laboratory Diagnosis, and Antimicrobial Resistance: a Perspective of Clinical Relevance. Clin Microbiol Rev 2022; 35:e0025821. [PMID: 35404105 PMCID: PMC9491184 DOI: 10.1128/cmr.00258-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite the recent decrease in overall prevalence of Helicobacter pylori infection, morbidity and mortality rates associated with gastric cancer remain high. The antimicrobial resistance developments and treatment failure are fueling the global burden of H. pylori-associated gastric complications. Accurate diagnosis remains the opening move for treatment and eradication of infections caused by microorganisms. Although several reports have been published on diagnostic approaches for H. pylori infection, most lack the data regarding diagnosis from a clinical perspective. Therefore, we provide an intensive, comprehensive, and updated description of the currently available diagnostic methods that can help clinicians, infection diagnosis professionals, and H. pylori researchers working on infection epidemiology to broaden their understanding and to select appropriate diagnostic methods. We also emphasize appropriate diagnostic approaches based on clinical settings (either clinical diagnosis or mass screening), patient factors (either age or other predisposing factors), and clinical factors (either upper gastrointestinal bleeding or partial gastrectomy) and appropriate methods to be considered for evaluating eradication efficacy. Furthermore, to cope with the increasing trend of antimicrobial resistance, a better understanding of its emergence and current diagnostic approaches for resistance detection remain inevitable.
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Affiliation(s)
- Shamshul Ansari
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu City, Oita, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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Akada J, Tshibangu-Kabamba E, Tuan VP, Kurogi S, Matsuo Y, Ansari S, Doohan D, Phuc BH, Subsomwong P, Waskito LA, Binh TT, Nguyen LT, Khien VV, Dung HDQ, Miftahussurur M, Syam AF, Tshering L, Vilaichone RK, Mahachai V, Ratanachu-Ek T, Shrestha PK, Yee TT, Htet K, Aftab H, Matsuhisa T, Uchida T, Okimoto T, Mizukami K, Kodama M, Murakami K, Takahashi N, Yamaoka Y. Serum Helicobacter pylori antibody reactivity in seven Asian countries using an automated latex aggregation turbidity assay. J Gastroenterol Hepatol 2021; 36:2198-2209. [PMID: 33609333 DOI: 10.1111/jgh.15467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/28/2021] [Accepted: 02/14/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM To determine the application range of diagnostic kits utilizing anti-Helicobacter pylori antibody, we tested a newly developed latex aggregation turbidity assay (latex) and a conventional enzyme-linked immunosorbent assay (E-plate), both containing Japanese H. pylori protein lysates as antigens, using sera from seven Asian countries. METHODS Serum samples (1797) were obtained, and standard H. pylori infection status and atrophy status were determined by culture and histology (immunohistochemistry) using gastric biopsy samples from the same individuals. The two tests (enzyme-linked immunosorbent assay and latex) were applied, and receiver operating characteristics analysis was performed. RESULTS Area under the curve (AUC) from the receiver operating characteristic of E-plate and latex curves were almost the same and the highest in Vietnam. The latex AUC was slightly lower than the E-plate AUC in other countries, and the difference became statistically significant in Myanmar and then Bangladesh as the lowest. To consider past infection cases, atrophy was additionally evaluated. Most of the AUCs decreased using this atrophy-evaluated status; however, the difference between the two kits was not significant in each country, but the latex AUC was better using all samples. Practical cut-off values were 3.0 U/mL in the E-test and 3.5 U/mL in the latex test, to avoid missing gastric cancer patients to the greatest extent possible. CONCLUSIONS The kits were applicable in all countries, but new kits using regional H. pylori strains are recommended for Myanmar and Bangladesh. Use of a cut-off value lower than the best cut-off value is essential for screening gastric cancer patients.
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Affiliation(s)
- Junko Akada
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | | | - Vo Phuoc Tuan
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan.,Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Shusaku Kurogi
- Clinical Laboratory Center, Oita University Hospital, Yufu, Japan.,Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuichi Matsuo
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Shamshul Ansari
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Dalla Doohan
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan.,Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Bui Hoang Phuc
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Phawinee Subsomwong
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Langgeng Agung Waskito
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan.,Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Tran Thanh Binh
- Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Lam Tung Nguyen
- Department of Hepatogastroenterology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Van Khien
- Department of Hepatogastroenterology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Ho Dang Quy Dung
- Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Muhammad Miftahussurur
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia.,Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Airlangga University, Surabaya, Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Intestinal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Lotay Tshering
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ratha-Korn Vilaichone
- Gastroenterology Unit, Digestive Diseases Research Center, Thammasat University Hospital, Khlong Luang, Thailand.,Department of Medicine, Chulabhorn International College of Medicine, Thammasat University Hospital, Khlong Luang, Thailand
| | | | | | - Pradeep Krishna Shrestha
- Department of Gastroenterology, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Than Than Yee
- Department of GI and HBP Surgery, No (2) Defense Service General Hospital, Nay Pyi Taw, Myanmar
| | - Kyaw Htet
- Department of GI and HBP Surgery, No (1) Defense Service General Hospital, Mingaladon, Myanmar
| | - Hafeza Aftab
- Department of Gastroenterology, Dhaka Medical Collage and Hospital, Dhaka, Bangladesh
| | - Takeshi Matsuhisa
- Department of Gastroenterology, Tama-Nagayama University Hospital, Nippon Medical School, Tama, Japan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tadayoshi Okimoto
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Masaaki Kodama
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan.,Faculty of Welfare and Health Science, Oita University, Yufu, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan
| | | | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan.,Global Oita Medical Advanced Research Center for Health, Oita University, Yufu, Japan.,Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
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Kawai S, Arai K, Lin Y, Nishiyama T, Sasakabe T, Wang C, Miwa H, Kikuchi S. Comparison of the detection of Helicobacter pylori infection by commercially available serological testing kits and the 13C-urea breath test. J Infect Chemother 2019; 25:769-773. [PMID: 31023569 DOI: 10.1016/j.jiac.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Serum Helicobacter pylori (H. pylori) antibody kits (LZ and LIA) using the latex agglutination immunoassay method are commercially available, but few studies have been performed to determine their diagnostic accuracy or to compare their results with those of enzyme-linked immunosorbent assay (ELISA) kits (EP and EIA). METHODS Sera were obtained from 213 hospital outpatients with dyspeptic symptoms. The serological results were compared with the result of the 13C-urea breath test (UBT) which seems to be reliable. RESULTS Of the 213 subjects, 154 were diagnosed as positive for H. pylori infection according to the UBT. The sensitivities and specificities of these tests were 97.4% and 76.3%, 98.1% and 78.0%, 99.4% and 74.6%, and 98.1% and 71.2% for the EP, LZ, EIA and LIA tests, respectively. When the 13 subjects whose seropositive results of the four kits were completely opposite to the negative results of the UBT were excluded, the specificities of evaluated kits were all higher than 90%. The concordance rate between the EP and EIA tests was 98.1% (Spearman's rank correlation coefficient = 0.83) and that between the LZ and LIA tests was 97.1% (correlation coefficient = 0.91). The LZ gave higher antibody titer value than EP (p < 0.0001, Z = 9.82; Wilcoxon signed-rank test), and EIA gave higher value than LIA (p < 0.0001, Z = 6.43; Wilcoxon signed-rank test). CONCLUSIONS The latex immunoassay method provided the same reliability to ELISA in terms of the diagnostic accuracy for current H. pylori infection, although we should take into account the titer value differences by each test method in practical use.
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Affiliation(s)
- Sayo Kawai
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan
| | - Kensuke Arai
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan
| | - Yingsong Lin
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan
| | - Takeshi Nishiyama
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan; Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tae Sasakabe
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan
| | - Chaochen Wang
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shogo Kikuchi
- Department of Public Health, Aichi Medical University, School of Medicine, Aichi, Japan.
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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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Valle PC, Breckan RK, Mortensen L, Amin A, Kildahl-Andersen O, Paulssen EJ. Managing dyspepsia in the young adult patient: effects of different tests for Helicobacter pylori in a "test-and-scope" approach. Scand J Gastroenterol 2013; 48:913-20. [PMID: 23865590 DOI: 10.3109/00365521.2013.800988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To evaluate how different methods for the detection of Helicobacter pylori influence on a "test, score and scope" decision approach in young dyspeptic patients. RESULTS Complete data from 341 patients (52.2% males) were analyzed. One hundred and ten (32%) were H. pylori-positive by definition. The rapid serology test was true-positive in 64 patients, false-positive in 8, and false-negative in 46. For the EIA IgG serology test, the corresponding results were 99 true-positive, 7 false-positive, and 11 false-negative. If the H. pylori fecal test or urea breath test had been applied, 108 (98%) and 107 (97%) positives would have been correctly detected, respectively, as well as 14 and 7 false positives. Models using test data in a setting of decreasing H. pylori prevalence show that test properties have increasing significance. CONCLUSIONS In a selection strategy for young dyspeptics based on the detection of H. pylori, the choice of test should be made with caution. H. pylori fecal test would probably give the best basis for such selection.
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Affiliation(s)
- Per C Valle
- Department of Internal Medicine, University Hospital of North Norway, Harstad, Norway.
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Basinska T, Wisniewska M, Chmiela M. Principle of a New Immunoassay Based on Electrophoretic Mobility of Poly(styrene/?-tert-butoxy-?-vinylbenzyl-polyglycidol) Microspheres: Application for the Determination ofHelicobacter pylori IgG in Blood Serum. Macromol Biosci 2005; 5:70-7. [PMID: 15635718 DOI: 10.1002/mabi.200400112] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The principle of a novel latex diagnostic test for the determination of antibodies against Helicobacter pylori in blood sera is described. The test is based on the measurement of the electrophoretic mobility of the microspheres with immobilized H. pylori antigens. The electrophoretic mobility of these microspheres depends on the concentration of the antibodies against H. pylori in suspending medium. Particles with hydrophilic polyglycidol in the surface layer were used for the test. The microspheres were obtained by an emulsifier-free emulsion copolymerization of styrene and alpha-tert-butoxy-omega-vinylbenzyl-polyglycidol macromonomer (D(n) = 220 nm, diameter polydispersity factor D(w)//D(n) = 1.02). Activation of polyglycidol hydroxyl groups with cyanuric chloride allowed for covalent immobilization of H. pylori antigens. The fraction of H. pylori not specifically adsorbed onto the microspheres was negligible. Changes of the electrophoretic mobility of the microspheres with the surface concentration of the covalently immobilized H. pylori antigens Gamma = (1.6 +/- 0.3) . 10(-3) g m(-2) were suitable for the detection of the antibodies in the sera of patients with titer in the range (determined by the indirect ELISA test) from 1:500 to 1:32 000.
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Affiliation(s)
- Teresa Basinska
- Center of Molecular and Macromolecular Studies, Polish Academy of Sciences, ul. Sienkiewicza 112, 90-363 Lodz, Poland.
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Gisbert JP, Vázquez MA, Cantero J, Pajares JM. [Study of the validity of "rapid" serology in diagnosing Helicobacter pylori infection]. Aten Primaria 2002; 30:501-6. [PMID: 12427373 PMCID: PMC7679667 DOI: 10.1016/s0212-6567(02)79087-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate prospectively the validity of a <<rapid>> serology diagnosis method (using capillary blood) in our ambit, taking for reference a combination of standard diagnostic methods. DESIGN Prospective. The endoscopist, pathologist and those responsible for interpreting the rapid urease test, the breath test and <<rapid>> serology did not know the results of the other diagnostic methods. SETTING Gastro-enterology service of a tertiary hospital.Participants. 30 consecutive patients with symptoms attributable to the upper digestive tract and who underwent an oral gastroscopy. Main measurements. Gastric biopsies for histology examination and for the rapid urease test and a breath test with 13C-urea were conducted. For <<rapid>> serology, the commercial SureStep HP WB test kit was used. A patient was considered infected when at least two of the three validated techniques (rapid urease test, histology, breath test) were positive; and not infected, when all three were negative. RESULTS 30 patients, 30% male, with a mean age of 51, were included. The reference standard indicated 61% prevalence of infection, with two cases classed as undetermined. <<Rapid>> serology was positive in 8 patients and negative in 22. Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 41% (95% CI, 18-65), 91% (74-100), 87% (65-100) and 50% (28-72). The positive probability quotient was 4.5; and the negative, 0.65. CONCLUSION The <<rapid>> serology used in the current study has deficient diagnostic accuracy. Therefore, it should not be used in clinical practice to identify H. pylori infection.
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Midolo PD, Dakic B, Nicholson L, Lambert JR, Lin S, Russell EG. Use of a dry latex agglutination test to measure eradication of Helicobacter pylori infection. J Gastroenterol Hepatol 2000; 15:254-6. [PMID: 10764024 DOI: 10.1046/j.1440-1746.2000.02081.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND METHODS A total antibody latex serology test was compared with enzyme immunoassay serology after treatment for Helicobacter pylori infection in 22 patients. RESULTS Nineteen patients were cured of infection, but only nine (47%) were negative by the latex test after 6 months. However a significant decline in immunoglobulin (Ig)G was seen in 90% of the cured patients. CONCLUSIONS Although the latex test is suitable for initial diagnosis of H. pylori infection, it is not suitable for monitoring treatment success. A decline in IgG of more than 40% correlates well with successful eradication of H. pylori.
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Affiliation(s)
- P D Midolo
- Department of Microbiology, Southern Cross Pathology, Southern Health Care Network, Monash Medical Centre, Clayton, Victoria, Australia.
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Vyas SP, Sihorkar V. Exploring novel vaccines against Helicobacter pylori: protective and therapeutic immunization. J Clin Pharm Ther 1999; 24:259-72. [PMID: 10475984 DOI: 10.1046/j.1365-2710.1999.00226.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infection of human stomach by Helicobacter pylori, a gram negative spiral bacterium first isolated in 1983 from a patient with chronic active gastritis (1), causes nearly all duodenal ulcers and most gastric ulcers and is associated with an increased risk of gastric adenocarcinoma (2). Current therapies for gastric infections include combination triple or quadruple therapy of antimicrobial and/or antiulcer agents for eradication of H. pylori infection (3). Development of the resistant strains and ecological niche (habitant) of the bacteria may cause relapse after the termination of the therapy. However, if effective, the high cost, difficulty of patient compliance and risk of selection for resistant strains make these therapeutic regimens impractical on a large scale, though effective on the laboratory trial stages. Studies of the pathogenesis of H. pylori have led to the identification of bacterial antigens and adherin proteins as candidates for inclusion as novel vaccines against these diseases (4-7). Both prophylactic and therapeutic vaccination have been demonstrated in animal models of H. pylori infection (8-10).
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Affiliation(s)
- S P Vyas
- Department of Pharmaceutical Sciences, Dr. Harisingh Gour University, Sagar, India.
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Vaira D, Holton J, Menegatti M, Ricci C, Landi F, Ali' A, Gatta L, Acciardi C, Farinelli S, Crosatti M, Berardi S, Miglioli M. New immunological assays for the diagnosis of Helicobacter pylori infection. Gut 1999; 45 Suppl 1:I23-7. [PMID: 10457032 PMCID: PMC1766658 DOI: 10.1136/gut.45.2008.i23] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
There are several types of immunological tests available for the diagnosis and management of Helicobacter pylori infection. Most commercially available serological kits use the enzyme linked immunosorbent assay (ELISA) test format. Originally the kits used crude antigen preparations although many of the newer kits use a more purified antigen preparation, with often increased specificity but lower sensitivity. Near patient test kits are based either on latex agglutination or immunochromatography. Generally they have low sensitivities compared with laboratory tests. Western blotting, ELISA, and recombinant immunoblot assays (RIBA) have also been developed into commercially available kits and can be used to indicate the presence of specific virulence markers. An antigen detection kit has been developed for the detection of Helicobacter pylori in faeces. Immunological reagents have also been combined with other diagnostic modalities to develop immunohistochemical stains and DNA immunoassays. Helicobacter pylori is now recognised as the cause of gastritis and most cases of peptic ulcer disease (PUD); its long term carriage increases the risk of gastric adenocarcinoma sixfold and it is designated as a class I carcinogen. H pylori has also been implicated as a cause of gastric mucosa associated lymphoid tissue lymphomas. Its relation to non-ulcer dyspepsia remains controversial. Additionally, long term carriage of the organism may be associated with short stature in young girls and, in the general population, as a possible risk factor for the development of vasospastic disorders and possibly skin immunopathology such as urticaria. With the recognition of H pylori as an important human pathogen, it has become one of the growing number of organisms to have its complete genome sequence mapped. Serology is an important method of determining colonisation status and can be used for diagnosis, as a screening procedure, or to follow the efficacy of eradication regimens. Most serological assays are in the ELISA format although some are based on the latex agglutination reaction. These latter are used principally as near patient assays. Most assays detect IgG in serum although some detect serum IgA. More recently developed assays detect IgA in saliva and the production of affinity purified antibodies has led to the development of an antigen detection assay for faecal specimens. Serological reagents have also been used in immunocytochemistry and to speed up the detection of amplified products of the polymerase chain reaction (PCR)-DNA immunoassays.
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Affiliation(s)
- D Vaira
- Department of Internal Medicine, University of Bologna, Bologna, Italy
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Lozniewski A, Muhale F, Hatier R, Marais A, Conroy MC, Edert D, le Faou A, Weber M, Duprez A. Human embryonic gastric xenografts in nude mice: a new model of Helicobacter pylori infection. Infect Immun 1999; 67:1798-805. [PMID: 10085020 PMCID: PMC96530 DOI: 10.1128/iai.67.4.1798-1805.1999] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In vitro or animal models have been used to investigate the pathogenesis of Helicobacter pylori infection. However, extrapolation to humans of results obtained with these heterologous models remains difficult. We have developed a new model for the study of H. pylori infection that uses human entire embryonic stomachs engrafted in nude mice. At 80 days after implantation, 22 of these xenografts, which exhibited a mature gastric epithelium, were inoculated with 10(7) to 10(8) CFU of either H. pylori LB1, a freshly isolated H. pylori strain (n = 12), or H. pylori ATCC 49503 (n = 10). After 12-week examination, H. pylori LB1 persistently colonized the antrum of all inoculated grafts, as assessed by culture (mucus and mucosa), immunohistochemistry (mucosa), and a rapid urease test (mucus). H. pylori ATCC 49503, either before or after in vivo passage, permitted only a transient 2-week colonization in one of the five inoculated grafts in both groups. Colonization was always associated with an increase of gastric juice pH. A mild neutrophil infiltration of the gastric mucosa was noted solely in infected grafts. Transmission electron microscopy showed adherence of H. pylori organisms to epithelial cell surface. In six animals, intracytoplasmic location of this bacterium was observed in the antrum or the fundus. These results allow us to propose this model as a new ex vivo model for the study of specific H. pylori-gastric cell interactions.
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Affiliation(s)
- A Lozniewski
- Laboratoire de Bactériologie-Virologie UMR CNRS 75-65, Faculté de Médecine, 54505 Vandoeuvre-les-Nancy, France.
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12
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Laheij RJ, Straatman H, Jansen JB, Verbeek AL. Evaluation of commercially available Helicobacter pylori serology kits: a review. J Clin Microbiol 1998; 36:2803-9. [PMID: 9738024 PMCID: PMC105068 DOI: 10.1128/jcm.36.10.2803-2809.1998] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- R J Laheij
- Department of Gastroenterology, University Hospital Nijmegen, Nijmegen, The Netherlands.
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13
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Amano K, Yokota S, Ishioka T, Hayashi S, Kubota T, Fujii N. Utilization of proteinase K-treated cells as lipopolysaccharide antigens for the serodiagnosis of Helicobacter pylori infections. Microbiol Immunol 1998; 42:509-14. [PMID: 9719104 DOI: 10.1111/j.1348-0421.1998.tb02317.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We have evaluated the use of proteinase K (PK)-treated cells isolated from Helicobacter pylori as lipopolysaccharide (LPS) antigens in an immunoblot assay and an enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of H. pylori infection. The sera from patients with chronic gastritis, gastric ulcer, duodenal ulcer or gastric cancer, and from healthy adults with or without H. pylori infection were assayed with three commercial serodiagnostic kits (HM-CAP, Helico-G, and G.A.P. II) and novel methods relying on the use of PK-treated cells. The PK-treated cells used in these assays were selected on the basis of their possibility to possess a common epitope in the O-polysaccharides of H. pylori, which is known to be highly immunogenic in humans. Of the sera from these patients, 71-94% were positive with the commercial kits, 97% with immunoblot assay, and 90% with ELISA. On the other hand, of the healthy adults infected with H. pylori, 72-97% were positive with the commercial kits, 86% with immunoblot assay, and 72% with ELISA. PK-treated cells that did not contain the common epitope were unsuitable as an antigen for immunoblot assay or ELISA. Furthermore, the reactivity of these sera reacted specifically with H. pylori PK-treated cells but not with LPSs from other gram-negative bacteria, such as Campylobacter, Proteus, Bordetella, and Salmonella. These results demonstrate that the serological assays relying on the use of H. pylori PK-treated cells possessing a highly antigenic epitope are potentially useful as a serodiagnostic test for H. pylori infection.
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Affiliation(s)
- K Amano
- Central Research Laboratory, Akita University School of Medicine, Akita, Japan
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14
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Vaira D, Holton J, Menegatti M, Landi F, Ricci C, Ali A, Gatta L, Farinelli S, Acciardi C, Massardi B, Miglioli M. Blood tests in the management of Helicobacter pylori infection. Italian Helicobacter pylori Study Group. Gut 1998; 43 Suppl 1:S39-46. [PMID: 9764039 PMCID: PMC1766597 DOI: 10.1136/gut.43.2008.s39] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There are three main types of blood test available for the management of Helicobacter pylori infection: those that detect an antibody response; tests of the pathophysiological state of the stomach; and those that indicate an active infection. Enzyme linked immunosorbent assay (ELISA) based kits are the most numerous of the commercially available tests. Originally the kits used crude antigen preparations but many of the newer kits use a more purified antigen preparation giving increased specificity but a lower sensitivity. The sensitivity, specificity, and predictive values of the tests can also be affected by the population under test and coexistent disease in the patients. Near patient test kits are based on either latex agglutination or immunochromatography. Generally, they have low sensitivities compared with laboratory tests. Commercial western blotting kits have also been developed and are used to detect the presence of specific virulence markers. The exact role of serology in the management of Helicobacter infection has still to be defined, although there is evidence that, used as a screening procedure, it can reduce endoscopy cost and workload. Gastrin and pepsinogen blood concentrations may provide valuable information on the pathophysiological state of the stomach--for example, the presence of inflammation or gastric atrophy. A combination of serology and serum concentrations of gastrin and pepsinogen may be used effectively to detect serious gastroduodenal disease in patients.
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Affiliation(s)
- D Vaira
- Department of Internal Medicine, University of Bologna, Italy
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Enroth H, Rigo R, Hultén K, Engstrand L. Diagnostic accuracy of a rapid whole-blood test for detection of Helicobacter pylori. J Clin Microbiol 1997; 35:2695-7. [PMID: 9316940 PMCID: PMC230043 DOI: 10.1128/jcm.35.10.2695-2697.1997] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this study, we evaluated a rapid whole-blood test, BM-test Helicobacter pylori, for detection of H. pylori infection in 144 and 48 patients with other gastrointestinal symptoms and with gastric cancer, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the test correlated well with the standards used for the calculation, i.e., serology by enzyme-linked immunosorbent assay or culture and histology.
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Affiliation(s)
- H Enroth
- Department of Clinical Microbiology, University Hospital, Uppsala, Sweden
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16
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ENROTH HELENA, ENGSTRAND LARS. Rapid detection ofHelicobacter pyloriinfection in serum and whole-blood samples. APMIS 1997. [DOI: 10.1111/j.1699-0463.1997.tb05106.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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