Advantages of serological testing for Helicobacter pylori infection as a screening test.

As the practicing physicians start treating all dyspeptic symptoms as peptic ulcer disease and some patients are treated for Helicobacter pylori infection without confirmation of infection. Hence, a simple and convenient test to identify the H. pylori infection is essential in the management of all dyspepsia. Serological test is a noninvasive test and result can be obtained within short time and treatment can be started early. Methods: A total of 86 outpatients with dyspeptic symptoms underwent both serological test and endoscopy and biopsy for H. pylori infection. Serological testing for H. pylori is based on the immunoglobulin G antibody to H. pylori infection. Results: Of 86 patients, 79 patients’ biopsy were positive for H. pylori and 77 patients were positive by serology. Of them, 75 were both positive for H. pylori by biopsy and also by serology. Those 7, who are negative for histology is also negative for serology. Comparing endoscopic biopsy with serology, the specificity, sensitivity are 97.5, 98 for serology. Conclusions: Serological tests assess the global presence of H. pylori in the stomach even when the bacteria are irregularly distributed on the gastric mucosa. Serology testing is cheaper and more convenient, and thus should be preferred in situations where the additional information yielded by an endoscopy is not needed.

Evaluación para comparar dos esquemas de terapia estándar (7 frente a 10 días) contra el Helicobacter pylori, con seguimiento clínico a 1 año / Randomized study of seven days of standard treatment for Helicobacter Pylori vs. ten days of standard treatment for Helicobacter Pylori with one year follow-ups of patients

Antecedentes: la creciente resistencia del Helicobacter pylori a los antibióticos induce el fracaso de la terapia de erradicación, por lo que se pretende modificar no solo la duración de la misma sino el régimen de antibióticos. Materiales y métodos: luego de una asignación aleatorizada se compararon dos esquemas de tratamiento estándar (7 [grupo 1] frente a 10 días [grupo 2]) con omeprazol 20 mg más amoxicilina 1 g y claritromicina 500 mg, todos vía oral (VO) cada 12 horas en pacientes con dispepsia no ulcerosa (DNU) y dispepsia ulcerosa (DU), para evaluar la efectividad de la erradicación con la prueba o test del aliento. Al año se comparó de nuevo la respuesta clínica de cada una de las terapias en los pacientes con DNU y DU. Se evaluó, además, la tolerancia a la terapia en cada grupo. Resultados: se asignaron aleatoriamente 149 pacientes al grupo 1 y 144 pacientes al grupo 2. La tasa de erradicación en el análisis por intención a tratar fue del 67,8% en el grupo 1 y del 74,3% en el grupo 2 (p=0,24), y en el análisis por protocolo fue del 72,1% y 81,1% (p=0,08), respectivamente. La tasa de erradicación fue similar para ambos grupos independiente del grado de infección por H. pylori (p=0,22) y no se encontraron diferencias en el grado de infección y la presencia de DNU o DU (p=0,19). Los efectos adversos fueron más frecuentes en el grupo 2 (27,5% frente a 36,1%), aunque sin relevancia estadística (p=0,4). La tasa de erradicación para ambos grupos fue similar para los pacientes con DNU (73,8% frente a 81,1%) y DU (64,3% frente a 73%). El seguimiento al año mostró que las manifestaciones clínicas no se relacionaron con el hecho de haber erradicado o no la bacteria (p=0,7), pese a que la respuesta clínica de los pacientes con DU fue mejor que la observada para los pacientes con DNU. Conclusiones: la terapia estándar durante 7 o 10 días es insuficiente para la erradicación del H. pylori, independiente del grado de infección por este microorganismo ...

Background: The increasing resistance of H pylori to antibiotics has led to failures of eradication treatment. For this reason we intend to modify both the duration of treatment and the regime of antibiotics. Methods: After random allocation, the standard treatment with omeprazole 20 mg orally every 12 hours, amoxicillin 1 g VO every 12 hours and clarithromycin 500 mg orally every 12 hours for 7 days (group 1) was compared with the same antibiotic regime over 10 days (group 2). Patients had either non-ulcer dyspepsia (NUD) or ulcer dyspepsia (UD). Effectiveness of eradication was evaluated with breathe tests. A year later, clinical responses to each therapy were compared for patients with NUD and DU. The tolerance to therapy was also evaluated for each group. Results: 149 patients were randomly assigned to group 1 and 144 patients to group 2. The eradication rate as measured by ITT analysis was 67.8% in group 1 and 74.3% in group 2 (p = 0.24). It was 72.1% and 81. 1% (p = 0.08) respectively for per protocol analysis. The eradication rate was similar for both groups independently of the degree of H pylori infection (p = 0.22). Differences in the degree of infection and the presence of NUD or DU (p = 0.19) were not found. Adverse effects were more frequent in group 2 (27.5% vs. 36.1%), but without statistical relevance (p = 0.4). The eradication rate was similar for patients with NUD (73.8% vs. 81,1%) and DU (64.3% vs. 73%). Follow up examinations one year later showed that the clinical manifestations were not related to the whether or not bacteria had been eradicated (p = 0.7). Nevertheless, the clinical response of patients with DU was better than for those with NUD. Conclusions: Standard therapy for either 7 or 10 days is insufficient for eradication of H pylori independent of the degree of H pylori infection or the type of endoscopic finding (NUD or DU). Both therapies show suboptimal eradication rates and poor clinical responses at ...

Comments on Evaluation of Endoscopic Findings and Detection of H. pylori Antibody by Serum IgG ELISA.

Bangladesh is a developing country with high prevalence of peptic ulcer disease and H. pylori infection. During the period of January 2007 to December 2007, a cross sectional study was conducted. In this study, serum samples were collected from 86 dyspeptic patients undergoing upper GIT endoscopy to determine anti-H. pylori IgG antibody by serum ELISA and was evaluated with endoscopic findings. Out of 86 study patients, gastro-duodenal mucosa was found normal in 58.14%, gastritis in 11.63%, duodenitis 2.33%, reflux oesophagitis 4.65%, peptic ulcer 17.44% and carcinoma of stomach 5.81%. Among 86 study population, 68 were serum IgG ELISA positive and 20 were negative.

Comparison of Helicobacter pylori Eradication Rate in Patients with Non-ulcer Dyspepsia and Peptic Ulcer Diseases according to Proton Pump Inhibitors / 대한소화기학회지

BACKGROUND/AIMS: Conflicting results have been reported whether patients with non-ulcer dyspepsia (NUD) respond differently to Helicobacter pylori (H. pylori) eradication treatment compared with patients with peptic ulcer diseases (PUD). The aim of this study was to evaluate any difference in H. pylori eradication rates between patients with NUD and PUD according to each proton pump inhibitor (PPI). METHODS: From September, 2004 to April, 2007, we retrospectively reviewed 2,297 patients with NUD (1,050 patients) or PUD (1,247 patients) infected with H. pylori. All patients received a standard 1 week triple therapy comprising of one of the five PPIs (pantoprazole, esomeprazole, omeprazole, lansoprazole, rabeprazole), clarithromycin and amoxicillin. The follow-up H. pylori test was performed 4 weeks after the completion of therapy. RESULTS: There was no significant difference in the eradication rates between the two groups. In comparison of eradication rates according to PPI, omeprazole- based triple therapy group showed higher eradication rate than other groups in patients with NUD, but not in patients with PUD. CONCLUSIONS: This study failed to show any difference in H. pylori eradication rate between patients with NUD and PUD. There is no convincing evidence that the eradication rate may be affected by different PPI.

Alexithymia and non ulcer dyspepsia

BACKGROUND: The pathophysiology of non ulcer dyspepsia remains unknown. But Several related factors have been investigated and psychologic factor is one of the possible mechanism. Alexithymia was introduced to explain the psychopathology of psychosomatic disorder. Until now alexithymia has been variously shown to be associated with many psychosomatic disorder, psychiatric disorder, even medical patients. This study is designed to investigate whether non ulcer dyspepsia has more relationship with alexithymia than other illness. METHODS: To compare alexithymia tendency between non ulcer dyspepsia and general medical patients, we collected sample from January to September 1999. Each group of 72 patients were tested using Toronto Alexithymia Scale. RESULTS: A rate of 37.5% of alexithymia was found in the non ulcer dyspepsia group compared with significant lower rate of 19.4% in the general medical patients group. CONCLUSION: Non ulcer dyspepsia patients had more alexithymia compare to general medical patients. This finding shows the alexithymia could be part of the pathophysiology of non ulcer dyspepsia.

Endemic Fluorosis &Non-Ulcer Dyspepsia in J&K State.

The study was carried out to investigate the prevalence of endemic fluorosis in J&K State and cause of non-ulcer dyspepsia. A total of 1,61790 individuals in the age range of 5 to 70 years were studied. In district, Doda 90% of the population studied were suffering from dental fluorosis, 12% were having skeletal deformities as well as bony pains and 60% ofthe population above the age of 25 years were suffering from dyspepsia. In other districts only 26% of the population studied were having dental fluorosis, 7% had skeletal deformities and 42% were suffering from dyspepsia. The nuoride content in water of different sources ranged from 1.153 to 27.216 PPM. Two hundred patients suffering from dental and skeletal fluorosis, having severe symptoms of upper gastrioilllcstinal tract like retrosternal burning distention ofabdomen, pain epigastrium, sour eructations and excessive flatulence or constipation were studied alongwith 10 control normal subjects. Upper gastrointestinal endoscopy studies showcd that 82 patients had mild to moderate antritis and pyloritis, 35 had multiple erosions in stomach, 36 had duodenitis and 47 had normal study. Histopathological examination of biopsies of stomach and jejunum revealed non-specific changes but scanning electron microscopic examination showed scanty microvilli or bald epithelium of the nlucosa, surface abrasions, desquamated epithelium and classical cracked clay appearance. This study concludes that fluorosis is in endemic form in J&K State and non-ulcer dyspepsia 'is very common in these patients because of drinking of highly fluoridated waler.

Can Helicobacter pylori Serology Predict Non-Ulcer Dyspepsia in Young Dyspeptic Patients? / 대한소화기내시경학회지

BACKGROUND/AIMS: In western courtry, Helicobacter pylori (H. pylori) serology is a screening test for non-ulcer dyspepsia (NUD) before endoscopy in dyspeptic patients under 45 years old without alarm symptoms. The aim of this study was to determine the usefulness of H. pylori serology before endoscopy in Korea. METHODS: Six hundred and fifteen outpatients (M:F=339:276, mean age 43.6+/-13.8, range 15-81) with dyspepsia performed anti-H. pylori IgG (GAP or HM-CAP) and upper gastrointestinal endoscopy with biopsy. Exclusion criteria were alarm symptoms, history of gastrectomy, NSAID use and previous anti-H. pylori treatment. RESULTS: The prevalence of anti-H. pylori IgG was 61.0% in patients under and 40 years old and 63.8% in patients over 40 years old. There was no significant difference between age groups. For patients under and 40 years old, serology predicted all pathology except 5 gastric ulcer, 8 duodenal ulcer, 2 reflux esophagitis and 2 gastric submucosal tumor. The sensitivity and negative predictive value (76.7, 85.8%) in patients under and 40 years old were higher than that (61.9, 64.0%) in patients over 40 years old (p=0.037, p=0.001). CONCLUSIONS: H. pylori serology seems to be an acceptable screening test for NUD in dyspeptic patients under and 40 years old without alarm symptoms.

Comparison of stressful life events among peptic ulcer, not ulcer dyspepsia and control groups

BACKGROUND: Stress has been recognized as a risk factor to various disorders including peptic ulcer disease. Life events are universal which everybody experiences. This study was done to find out whether stressful life events have a role in the development and exacerbation of peptic ulcer disease (PUD) and non-ulcer dyspepsia(NUD) comparing Lee's life stress scale between patients with gastroscopically proven PUD and NUD and those of control. METHODS: On hundred twenty two patients with PUD were studied at our institution from February 1, 1997 to June 30, 1997. Patients who experienced abdominal discomfort and found to have normal or chronic superficial gastritis by gastroscopic exam during the same period were selected for NUD group. Controls were selected from asymptomatic individuals who underwent upper gastrointestinal series procedure for a health screening. Stressful life events investigated were total, positive, and negative stresses measured by Lee's life stress scale(98 items), marital status, level of education, income, occupation, religion, history of cigarette smoking, and the amount of alcoholic consumption and were compared between the three groups. The data were analyzed by one way ANOVA and chi-square test. RESULTS: No statistically significant difference was found in total, positive, and negative stress scores between PUD group and NUD group, although they were significantly higher in PUD and NUD groups than those of the control group(p<0.05). Also statistically significant difference in income and occupation, tests and school, problems associated children and familial conflict were found between PUD group and the control group(p<0.05), as well as between NUD group and the control group(p<0.05). CONCLUSION: Stressful life events were associated with development of PUD and NUD.

Irregular, quick meal is associated with non-ulcer dyspepsia

BACKGROUND: Many etiologies of Non-Ulcer Dyspepsia (NUD) have been suggested. Among them, gastrointestinal(GI) motility disorder seems to bean important cause. It is said that many Koreans have dyspepsia, due to rapid eating habit. Therefore, we investigated on specific eating habits that may influence GI motility resulting in NUD symptoms. METHODS: At the Health Promotion Center in a university hospital we screened 8,648 adults from May 1995 to April 1997. The patients were given a questionnaire on their eating habits, followed by history taking, physical examination, laboratory tests, UGIS (or gastrofiberoscopy), and abdominal sonography. And then the family physician evaluated the patients. Those with NUD and control who didnt have any diagnosis related to GI tract were analyzed. RESULTS: 1,329 persons(15.4%) were diagnosed as having NUD, and the number of control group were 4,747. NUD was more common in females(Odds Ratio=1.64). NUD group reported less regular eating(OR=0.77), and drinking(OR=0.60). NUD had significantly shorter meal duration, and lower BMI.(p<0.00). But there was no difference in the reported exercise, smoking, stress amount, frequency of eating salty food, breakfast, dinner, instant food, hot food, and the amount of each meal. CONCLUSIONS: NUD was associated with irregular, and quick eating behavior. Behavioral modification such as regular and slow eating to prevent NUD is advised.

Meta Analysis of Symptom Improvement through Eradication of Helicobacter pylori in Patients with Non-ulcer Dyspepsia / 예방의학회지

OBJECTIVES: This study was conducted to determine, by reviewing the literature, whether treatment of Helicobacter pylori infection in patients with non-ulcer dyspepsia affects symptoms. METHODS: We retrieved the literature using MEDLINE search, with nonulcer dyspepsia and Hericobacter pylori and treatment as key words, which were reported from 1984 to 1998, and manual literature search. The criteria for inclusion was as follows; 1) The paper should have confirmed nonulcer dyspepsia as case definition. 2) The paper should have performed a randomized, blind trial. 3) Confirmation of Helicobacter pylori eradication should be done 4 weeks after treatment. 4) studies with no information on measurement of symptoms after treatment were not accepted. The percentage of patients with symptom improvement after eradication therapy for Helicobacter pylori infection was calculated. Cumulative odds ratio was compared by fixed effect model and random effect model as sensitivity and funnel plot was used to evaluate publication bias. RESULTS: The overall effect size of symptom improvement was calculated by cumulative odds ratio. Cumulative odds ratio of random effect model was 4.16(95% CI: 1.55-11.19). Before integrating each effect sizes into common effect size, the homogeneity test was conducted and random effect model was selected(Cochran's Q=41.08 (d.f=10, p<0.001)). The heterogeneity across studies was evaluated and the different methodological aspects of studies led to differences between study results. CONCLUSIONS: The results suggest that the eradication of Helicobacter pylori in patients with non-ulcer dyspepsia results more symptom improvement. In studies that shows the opposite results there are methodological aspects explaining the heterogeneity.

Effect cisapride on gastric emptying and dyspeptic symptoms in children with non-ulcer dyspepsia.

The aim of our study was to determine the effect of Cisapride on gastric emptying and dyspeptic symptoms in 10 non-ulcer dyspepsia (NUD) children with delayed gastric emptying during and after stopping treatment. Five boys and five girls aged 5-11 years underwent upper endoscopy which showed normal appearing mucosa and histology. Solid gastric emptying was measured by scintigraphy before and after an eight-week course of oral Cisapride. The dose of cisapride was 0.2 mg/kg/dose (maximum 5 mg) three times before meals for eight weeks and then gradually decreased and discontinued when the symptoms improved. Symptoms were show to be 87.4+3.4 percent and 82.9 (4.5 percent at 60 minutes and 90 minutes, respectively. After eight-weeks of treatment, repeated gastric emptying studies were shown to be 69.1+10.6 percent and 56.7+14.1 percent respectively. This was statistically significant (P=0.001, 0.0001). In all 10 children the symptoms improved after eight-weeks of treatment. Seven children were followed up after stopping cisapride for 3 to 17.5 months. The overall response were excellent in four patients, moderate in two Cisapride is effective in improving dyspeptic symptoms and gastric emptying in children with NUD.

The pH of the Gastric Mucosal Surface and Helicobacter pylori Infection in Non-Ulcer Dyspepsia / 대한소화기내시경학회지

BACKGROUND/AIMS: The Helicobacter pylori(H. pylori) infection induces gastric mucosal injury through the various bacterial cytotoxins, the inflammatory reaction of the host and the increased gastric acid secretion. Urease is a kind of adaptive protein of H. pylori to survive in strong acid environment of the stomach, may increase the pH of the gastric mucosal surface and induces gastrin release by the feedback mechanism. This study was performed to evaluate whether 0.1% phenol red solution without urea is useful as a pH indicator of the gastric mucosa for the diagnosis of H. pylori infection in stomach and whether the pH of the gastric mucosal surface is changed by H. pylori infection. METHODS: The gastric mucosa was stained by 0.1% phenol red solution without urea during endoscopy in 89 patients with non-ulcer dyspepsia. The patterns of staining of the gastric mucosa were divided into unstained, patchy regional and diffuse staining by the area of color change from yellow to red. The pH of the gastric mucosal surface was measured directly on the stained and unstained areas of the gastric mucosa by using pH meter and antimony pH electrode through the biopsy channel. RESULTS: The pH of the stained areas after spray of phenol red solution was significantly higher(6.9) than that(1.9) of the unstained gastric mucosa(P<0.01). The patterns of the staining were different between antrum and body. The patterns of unstaining and patchy staining were more common in the body than in the antrum. But the patterns of regional and diffuse staining were more common in the antrum than in the body(P<0.05). The positive rates of H. pylori in antrum, body and total gastric biopsies were higher in stained than in unstained mucosa significantly(P<0.05). Severity of active inflammatory reactions was higher in stained mucosa than unstained mucosa in the antrum. But there was no difference in severity of active inflammatory reactions between stained mucosa and unstained mucosa in the body. CONCLUSIONS: 0.1% phenol red solution without urea is useful as a pH indicator for the diagnosis of the H. phlori infection in the stomach. H. pylori infection may increase the pH of gastric mucosal surface and induce severe active inflammation of the gastric mucosa in non-ulcer dyspepsia.

Clinical Significance of Gastroptosis / 대한내과학회지

OBJECTIVES: Gastroptosis is defined as a condition in which the gastric angel is located below the interiliac line in standing position in the UGI barium study. The present study was designed to evaluate its prevalence, relation to clinical symptoms, body weight and gastric emptying time. METHODS: Two hundred-twenty seven consecutive subjects undertaken a UGI barium study for general check-up. We analyzed age, sex distribution, body weight percentile according to ideal body weight, and clinical manifestations. Gastric emptying scan was performed with a semi-solid test meal (2mCi of labeled (99m)Tc-suifur colloid-scrambled egg) on 12 healthy, asymptomatic subjects and 17 patients with gastroptosis. RESULTS: Twenty-one (9.3%) of the 227 subjects had gastroptosis. The ratio of male to female was 1 to 4.57. In age, three (16.7%) of the patients were below the age 40, 14(8.9%) were between 40 to 49, 4(7.8%) were above 50. According to the percentile of ideal body weight, 4(8.6%) of the 14 subjects were under the 90 percentile, 15(12.6%) of the 179 subjects were between 90 to 110 percentile, and 2(0.02%) of the 94 were above 110 percentile, which significantly higher in that of under 110 percentile of ideal body weight. The symptoms, which were complained in 8 of the 21 patients, were epigastric discomfort, belching, hunger pain, constipation, and nausea. The mean gastric emptying time (T1/2) was 69.8min and 92.6min in control and gastroptosis group, respectively. T1/2 was delayed in 7(63.6%) patients with symptomatic gastroptosis and 1 control. CONCLUSION: The gastroptosis was more common in female and lower body weight group and had a tendency of delay in T1/2z. We consider that gastroptosis may be one of the possible cause of non-ulcer dyspepsia in Korea.

Eradicating helicobacter pylori and symptoms of non-ulcer dyspepsia: The effect of treatment with a combination of ranitidine and amoxicillin.

Although dyspepsia frequently occurs in general population, its causes are poorly understood. This study is aimed at determining the role of Helicobacter pylori in non-ulcer dyspepsia (NUD) and evaluating the efficacy of dual therapies for H.pylori. Two groups totaling of 39 patients with endoscopically-proven NUD participated in the study. One group, comprising of 23 patients, received 300 mg of ranitidine daily for 4 weeks together with 500 mg of amoxicillin four time a day for two weeks. The second group, comprising of 16 patients, received GacidaTM 1 tablet for 4 weeks together with 500 mg of amoxicillin four time a day for 2 weeks respectively. H.pylori status was determined by histology and CLO testTM before and in the fourth and eighth week after treatment. Thirty-six patients completed the study, 21 in the ranitidine treatment group and 15 in the GacidaTM group H.pylori was successfully eradication in 47.3 percent (9/21) of ranitidine treatment group. Symptom relief at the second and sixth weeks was significantly higher under ranitidine regimen at 90.47 percent (19/21) and 100 percent (21/21) respectively, compared with the gacida regimen at 46.66 percent (7/15) and 53.33 percent (8/15) respectively. The number of patients who were symptom-free at the sixth week of treatment was significantly higher in the ranitidine group at 71.4 percent (15/21), compared with the gacida group at 20 percent (3/15). We concluded that the ranitidine regimen can relief the symptoms of NUD patients with H.pylori infection. However, the role of H.pylori needs further studies.

Efficacy of colloidal bismuth subcitrate vs. cimetidine for treatment of helicobacter pylori positive non-ulcer dyspepsia.

We report an open trial study to determine the role of Helicobacter pylori (HP) in patients with non-ulcer dyspepsia (NUD) and to determine the effect of two drugs (colloidal bismuth subcitrate, CBS and cimetidine) on HP. Our study consisted of 48 patients, 30 received CBS two tablets twice daily and 18 received cimetidine 400 mg twice daily. The result of HP suppression detected by rapid urease test was 66.7% and 86.7% for CBS group after receiving the drug for 4 and 8 weeks respectively, for cimetidine only 11.1% urease test negative during the same period. Follow up urease test 19.2% of patients treated by CBS remained negative but none in the cimetidine group. AII patients felt better during treatment irrespective to status of HP. Our conclusion is that there is no correlation between HP status and NUD symptoms. To evaluate this relationship, further study must be done. To date there is no strong evidence to recommend HP eradication in HP associated NUP patients.