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Doohan D, Fauzia KA, Rathnayake J, Lamawansa MD, Waskito LA, Tuan VP, Dashdorj A, Kabamba ET, Phuc BH, Ansari S, Akada J, Matsumoto T, Uchida T, Matsuhisa T, Yamaoka Y. Pepsinogen and Serum IgG Detection Is a Valuable Diagnostic Method for Helicobacter pylori Infection in a Low-Prevalence Country: A Report from Sri Lanka. Diagnostics (Basel) 2021; 11:diagnostics11081364. [PMID: 34441303 PMCID: PMC8391933 DOI: 10.3390/diagnostics11081364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022] Open
Abstract
The use of serum anti-Helicobacter pylori IgG and pepsinogen (PG) detection as a diagnostic method was evaluated in Sri Lanka. Gastric biopsies were performed (353 patients), and the prevalence of H. pylori infection was 1.7% (culture) and 2.0% (histology). IgG serology testing showed an area under the curve (AUC) of 0.922 (cut-off, 2.95 U/mL; specificity, 91.56%; sensitivity, 88.89%). Histological evaluation showed mild atrophy (34.3%), moderate atrophy (1.7%), metaplasia (1.7%), chronic gastritis (6.2%), and normal tissue (56%). The PGI/PGII ratio was significantly higher in H. pylori-negative patients (p < 0.01). PGII and PGI/PGII levels were lower in patients with metaplasia than in those with normal mucosa (p = 0.049 and p < 0.001, respectively). The PGI/PGII ratio best discriminated metaplasia and moderate atrophy (AUC 0.88 and 0.76, respectively). PGI and PGII alone showed poor discriminative ability, especially in mild atrophy (0.55 and 0.53, respectively) and chronic gastritis (0.55 and 0.53, respectively). The best cut-off to discriminate metaplasia was 3.25 U/mL (95.19% specificity, 83.33% sensitivity). Anti-H. pylori IgG and PG assessment (ABC method) was performed (group B, 2.0%; group A, 92.1%). The new cut-off more accurately identified patients with metaplasia requiring follow-up (group B, 5.4%). Assessment of anti-H. pylori IgG and PG is valuable in countries with a low prevalence of H. pylori infection.
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Affiliation(s)
- Dalla Doohan
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Kartika Afrida Fauzia
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Jeewantha Rathnayake
- Department of Surgery, Teaching Hospital Peradeniya, University of Peradeniya, Kandy 20404, Sri Lanka; (J.R.); (M.D.L.)
| | - Meegahalande Durage Lamawansa
- Department of Surgery, Teaching Hospital Peradeniya, University of Peradeniya, Kandy 20404, Sri Lanka; (J.R.); (M.D.L.)
| | - Langgeng Agung Waskito
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Vo Phuoc Tuan
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh 749000, Vietnam
| | - Azzaya Dashdorj
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
| | - Evariste Tshibangu Kabamba
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Research Center for Infectious Sciences, Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan
| | - Bui Hoang Phuc
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
| | - Shamshul Ansari
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Department of Microbiology, Teaching Hospital, Chitwan Medical College, Bharatpur 44200, Nepal
| | - Junko Akada
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
| | - Takashi Matsumoto
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
| | - Tomohisa Uchida
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan;
| | - Takeshi Matsuhisa
- Department of Gastroenterology, Tama Nagayama University Hospital, Nippon Medical School, Tokyo 206-8512, Japan;
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (D.D.); (K.A.F.); (L.A.W.); (V.P.T.); (A.D.); (E.T.K.); (B.H.P.); (S.A.); (J.A.); (T.M.)
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX 77030, USA
- Global Oita Medical Advanced Research Center for Health (GO-MARCH), Faculty of Medicine, Oita University, Yufu 879-5593, Japan
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
- Correspondence: ; Tel.: +81-97-586-5740
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Kageyama C, Sato M, Sakae H, Obayashi Y, Kawahara Y, Mima T, Matsushita O, Yokota K, Mizuno M, Okada H. Increase in antibiotic resistant Helicobacter pylori in a University Hospital in Japan. Infect Drug Resist 2019; 12:597-602. [PMID: 30881065 PMCID: PMC6419596 DOI: 10.2147/idr.s196452] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Eradication effectively prevents Helicobacter pylori-associated diseases; however, H. pylori antibiotic resistance has increased throughout Japan and worldwide. This study aimed to assess rates of resistance to antibiotics; amoxicillin, clarithromycin and metronidazole in a University Hospital in Japan. Materials and methods H. pylori (208 strains) were isolated from patients at the Okayama University Hospital in Japan. The minimum inhibitory concentrations (MIC) were determined using the mean values of the E-test to determine the antimicrobial susceptibilities of the strains. Sequencing and gene analysis were performed to analyze resistance genes to clarithromycin and amoxicillin. Results Rates of amoxicillin, clarithromycin, and metronidazole resistance were 13%, 48%, and 49%, respectively. Genetic analysis indicated that the A2143G point mutation in 23S rDNA is closely associated with the MIC of clarithromycin. The MIC in amoxicillin-resistant strains increased with an increase in the number of PBP1A amino acids mutations. Conclusion Genetic analysis for resistant strains is not clinically effective in cases of amoxicillin resistance. Numerous bacteria with already high antibiotic resistance rates have been isolated in large hospitals such as a University Hospital. For effective eradication therapy, MIC measurement should be considered via several methods.
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Affiliation(s)
- Chihiro Kageyama
- Graduate School of Health Science, Medical Technology, Okayama University, Okayama 700-8558, Japan,
| | - Mayu Sato
- Graduate School of Health Science, Medical Technology, Okayama University, Okayama 700-8558, Japan,
| | - Hiroyuki Sakae
- Gastroenterology and Hepatology, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yuka Obayashi
- Gastroenterology and Hepatology, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Gastroenterology and Hepatology, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Takehiko Mima
- Bacteriology, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Osamu Matsushita
- Bacteriology, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kenji Yokota
- Graduate School of Health Science, Medical Technology, Okayama University, Okayama 700-8558, Japan,
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 710-8602, Japan
| | - Hiroyuki Okada
- Gastroenterology and Hepatology, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
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Bińkowska A, Biernat MM, Łaczmański Ł, Gościniak G. Molecular Patterns of Resistance Among Helicobacter pylori Strains in South-Western Poland. Front Microbiol 2018; 9:3154. [PMID: 30619218 PMCID: PMC6305312 DOI: 10.3389/fmicb.2018.03154] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/05/2018] [Indexed: 12/27/2022] Open
Abstract
Treatment failure of Helicobacter pylori infection is caused mainly by progressive antibiotic resistance among H. pylori strains. In Poland, the prevalence of H. pylori strains resistant to metronidazole is higher than in other developed countries, reaching almost 50%, and resistance to clarithromycin is as high as 30% and is still increasing, contributing to the failure of first-line therapy in approximately 70% of patients. Moreover, the introduction of levofloxacin to eradication therapy of H. pylori infection quickly led to the emergence of resistant strains. Therefore, a necessary approach in microbiological diagnostics of H. pylori infection should be determination of susceptibility of H. pylori strains before the eradication treatment. Aim: In this study was to evaluate the molecular mechanisms of resistance among 170 H. pylori strains to clarithromycin, involving mutations in the 23S rRNA gene (A2143G, A2142G, A2143G) and to levofloxacin, involving mutations of gyrA and gyrB. Analysis was performed by using polymerase chain reaction and classical sequencing of DNA fragments. Results: Among examined strains, 26% were fully sensitive and 74% were resistant to at least one of the tested antibiotics. The overall resistance rate to metronidazole was as high as 56%, whereas to clarithromycin 46%, respectively. Resistance to LEV occurred among 6% of strains. All tested strains were susceptible to AMC and TET. The A2143G point mutation was found in 72% of clarithromycin-resistant strains. The most common mutation, present in 40% of H. pylori strains resistant to levofloxacin, was a change at position 91 of gyrA. Conclusion: The increasing number of point mutations in the 23S rRNA gene leads to an increase in the rates of antimicrobial resistance. Presence of the GCG allele at position 122 of the gyrA gene may cause an eightfold increase in risk of development of resistance to levofloxacin.
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Affiliation(s)
- Aldona Bińkowska
- 2nd Military Field Hospital of the Polish Armed Forces, Wrocław, Poland
| | - Monika Maria Biernat
- Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Łukasz Łaczmański
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | - Grażyna Gościniak
- Department of Microbiology, Wrocław Medical University, Wrocław, Poland
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