Helicobacter Pylori Treatment Eradication in Egypt: Standard Clarithromycin-based Triple versus Quadruple Regimen Therapy

Absence of adequate treatment for Helicobacter pylori (H. pylori) infection leads to prolonged life time colonization which is responsible for complications. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency and tolerability of standard triple therapy vs. quadruple regimen therapy in H. pylori eradication in Egypt.

Standardizing Diagnosis of Helicobacter pylori Infection to Improve Diagnostic Accuracy / 胃肠病学

Eradication of Helicobacter pylori (Hp) is important for the prevention and treatment of chronic gastritis, peptic ulcer and gastric cancer. The Chinese consensus on the management of Hp infection has taken "confirmed Hp infection" as an indication for eradication. The World Gastroenterology Organisation global guideline states the "test-and-treat strategy" for Hp infection. Accurate diagnosis of Hp infection is a prerequisite for standardized eradication. There are many methods to diagnose Hp infection. Each has its advantages and disadvantages. Different methods are suitable for different diseases and patients, and each method has strict requirements for reagents, equipment, testers and patients. Therefore, increasing the awareness of physicians and testers about the standardized diagnosis of Hp infection is essential to improve the diagnostic accuracy.

Evaluating Diagnostic Tests for Helicobacter pylori Infection Without a Reference Standard: Use of Latent Class Analysis

Evaluation of diagnostic tests requires reference standards, which are often unavailable. Latent class analysis (LCA) can be used to evaluate diagnostic tests without reference standards, using a combination of observed and estimated results. Conditionally independent diagnostic tests for Helicobacter pylori infection are required. We used LCA to construct a reference standard and evaluate the capability of non-invasive tests (stool antigen test and serum antibody test) to diagnose H. pylori infection compared with the conventional method, where histology is the reference standard. A total of 96 healthy subjects with endoscopy histology results were enrolled from January to July 2016. Sensitivity and specificity were determined for the LCA approach (i.e., using a combination of three tests as the reference standard) and the conventional method. When LCA was used, sensitivity and specificity were 83.8% and 99.4% for histology, 80.0% and 81.9% for the stool antigen test, and 63.6% and 89.3% for the serum antibody test, respectively. When the conventional method was used, sensitivity and specificity were 75.8% and 71.1% for the stool antigen test and 77.7% and 60.7% for the serum antibody test, respectively. LCA can be applied to evaluate diagnostic tests that lack a reference standard.

Two cases of cholera O1 in South Batinah, Oman, April 2019: lessons learned / 한국역학회지

Cholera represents an ongoing threat to many low-income and middle-income countries, but some cases of cholera even occur in high-income countries. Therefore, to prevent or combat cholera outbreaks, it is necessary to maintain the capacity to rapidly detect cholera cases, implement infection control measures, and improve general hygiene in terms of the environment, water, and food. The 2 cases, 1 imported and 1 secondary, described herein are broadly indicative of areas that require improvement. These cases were missed at the primary health care stage, which should be the first detection point even for unusual diseases such as cholera, and the absence of strict infection control practices at the primary care level is believed to contribute to secondary cases of infection. This report also encourages countries to ensure that rapid diagnostic stool tests are available to enable quick detection, as well as to provide information to people travelling to areas where cholera is endemic.

Two cases of cholera O1 in South Batinah, Oman, April 2019: lessons learned / 한국역학회지

Cholera represents an ongoing threat to many low-income and middle-income countries, but some cases of cholera even occur in high-income countries. Therefore, to prevent or combat cholera outbreaks, it is necessary to maintain the capacity to rapidly detect cholera cases, implement infection control measures, and improve general hygiene in terms of the environment, water, and food. The 2 cases, 1 imported and 1 secondary, described herein are broadly indicative of areas that require improvement. These cases were missed at the primary health care stage, which should be the first detection point even for unusual diseases such as cholera, and the absence of strict infection control practices at the primary care level is believed to contribute to secondary cases of infection. This report also encourages countries to ensure that rapid diagnostic stool tests are available to enable quick detection, as well as to provide information to people travelling to areas where cholera is endemic.

Multicenter Study on the Association of Positive Helicobacter pylori Stool Antigen to Anemia in Children / 대한임상미생물학회지

BACKGROUND: Helicobacter pylori infection in children causes gastrointestinal symptoms and iron deficiency anemia. This study aimed to investigate trends in H. pylori stool antigen (HpSA) positivity in children and the relationship between HpSA test results and anemia. METHODS: We analyzed the results of 2,762 HpSA tests and the correlation of hemoglobin and ferritin with HpSA in patients aged 0–18 years from 2008 to 2014 at a tertiary care center. Additionally, we prospectively evaluated HpSA test results and correlation with hemoglobin in 352 specimens obtained from five centers. RESULTS: From 2008-2014, the mean positive rate of the HpSA test was 5.8%, with a high of 9.1% in 2012 and a low of 2.3% in 2013. The positive rate correlated with age: 2.9% in 0–6-year-olds, 5.8% in 7–12-year-olds, and 10.6% in 13–18-year-olds (P < 0.0001). There was no difference in HpSA positivity in patients with (7.0%) and without (5.7%) anemia. Ferritin was significantly lower in patients with positive HpSA results than in those with negative results (P=0.0001). In a multicenter study, the positive rate of HpSA was 16.8%. CONCLUSION: The rate of HpSA positivity was 5.8% in pediatric patients at a single center from 2008–2014, and this rate increased with age. Helicobacter pylori infection may be associated with iron deficiency, as ferritin level was significantly lower in HpSA-positive patients than HpSA-negative patients.

Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients.

Helicobacter pylori (HP) is causally associated with peptic ulcer disease and gastric carcinoma. Determination of the prevalence of HP infection in dyspepsia patients’ in particular geographical area is imperative for the appropriate management of dyspepsia. HP antigen detection in stool is a noninvasive diagnostic test of HP infection. This prospective study was conducted to find out the prevalence of HP infection based on stool antigen testing in dyspeptic patients who had also undergone upper gastrointestinal (GI) endoscopy. This study highlights the high prevalence of HP infection in dyspeptic Indian patients, particularly males, and emphasizes the growing importance of the bacterium causing infection among children. We also found HP stool antigen testing to be superior to upper GI endoscopy for detecting HP infection. Hence, we recommend initial testing for HP stool antigen in dyspeptic patients before initiating treatment and before carrying out any invasive procedure such as endoscopy.

Detection of Helicobacter felis in a cat with gastric disease in laboratory animal facility / 한국실험동물학회지

A 3-month-old male cat in the animal facility was presented for investigation of anorexia and occasional vomiting. We collected the specimens from gastroscopic biopsy and stool collection. The gastroscopic biopsy specimens were tested using a rapid urease test, CLO Helicobacter-detection kits. Stool specimens were gathered and evaluated using the commercially available SD Bioline H. pylori Ag kit according to the manufacturer's instructions. Genomic DNAs from gastroscopic biopsy and stool specimens of the cat were extracted and submitted to the consensus PCR to amplify Helicobacter rpoB gene. Then the DNAs from gastroscopic biopsy and stool specimens were conducted a multiplex species-specific PCR to amplify urease B gene for H. heilmannii, H. pylori and H. felis. As the results, the rapid urease test with gastroscopic biopsy was revealed positive reaction. The result of H. pylori Stool Ag assay was one red line, negative for H. pylori. The gastroscopic biopsy and stool specimen were positive reactions by the consensus PCR reaction using the RNA polymerase beta-subunit-coding gene (rpoB) to detect Helicobacter species. By multiplex species-specific PCR with gastroscopic biopsy and stool specimens, no amplification products corresponding to either H. heilmannii or H. pylori were detected, but the specimens tested were positive for H. felis. This case was confirmed as gastroenteric disease induced by H. felis infection. On our knowledge, this is a very rare report about H. felis-induced gastroenteric disease in cat and may provide a valuable data on the study of feline Helicobacter infection.

Updates on the Diagnosis of Helicobacter pylori Infection in Children: What Are the Differences between Adults and Children? / 대한소아소화기영양학회지

Helicobacter pylori infection is acquired mainly during childhood and causes various diseases such as gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphoma, and iron deficiency anemia. Although H. pylori infection in children differs from adults in many ways, this is often overlooked in clinical practice. Unlike adults, nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. Histopathological findings of gastric tissues are also different in children due to predominance of lymphocytes and plasma cells and the formation of gastric MALT. Although endoscopy is recommended for the initial diagnosis of H. pylori infection, several non-invasive diagnostic tests such as the urea breath test (UBT) and the H. pylori stool antigen test (HpSA) are available and well validated even in children. According to recent data, both the ¹³C-UBT and HpSA using enzyme-linked immunosorbent assay are reliable non-invasive tests to determine H. pylori status after eradication therapy, although children younger than 6 years are known to have high false positives. When invasive or noninvasive tests are applied to children to detect H. pylori infection, it should be noted that there are differences between children and adults in diagnosing H. pylori infection.

Comparison of three diagnostic assays for the identification of Helicobacter spp. in laboratory dogs / 한국실험동물학회지

A number of Helicobacter species may confound experimental data because of their association with disease progressing in various kinds of laboratory animals. Screening of Helicobacter species is particularly desirable, because they are prevalent in commercial and research animal facilities. The aim of the present study was to compare three diagnostic methods [e.g. Helicobacter stool antigen kit (HpSA), polymerase chain reaction (PCR) and rapid urease test (RUT)] for the identification of Helicobacter spp. in stools or gastric biopsy specimens collected from eight dogs suffering from gastritis. The gastroscopic biopsy specimens were tested using RUT and PCR, while stool specimens were evaluated using both HpSA and PCR. DNAs from the gastric biopsies and stool specimens were analyzed by both a consensus PCR that amplified the RNA polymerase beta-subunit-coding gene (rpoB) of Helicobacter spp. and a species-specific PCR to amplify the urease B gene of Helicobacter heilmannii, Helicobacter pylori, and Helicobacter felis. Helicobacter spp. were detected in 62.5% of the dogs, while H. heilmannii and H. felis were identified in 37.5 and 25% of the dogs, respectively. The HpSA did not efficiently detect Helicobacter spp. in the stool samples compared to the RUT and PCR assays, both of which successfully detected Helicobacter spp. in the two sample types. Finally, we recommend that consensus PCR with stool specimens could be used before the species-specific PCR for identifying Helicobacter species in laboratory dogs.

Evaluation of assays to detect Helicobacter felis infection in cats / 동물의과학연구지

Recently, several companies have released H. pylori stool antigen (HpSA) test kits. However, there is little information about the usefulness of HpSA testing for Helicobacter felis, which is the major Helicobacter species in cats. The aim of the present study was to compare diagnostic methods for diagnosis of H. felis with HpSA tests and PCR assay using cat stools or gastric mucosa. Male cats (n=6) were infected with H. felis ATCC 49179 (1.0 x 10(9) CFU /cat) by intragastric inoculation two times at 3-day intervals, and stool specimens of cats were collected 1, 3, 5, 7, 14, and 21 days after infection for HpSA testing and H. felis-specific PCR. For the results, sensitivities of the HpSA test and PCR analysis were 50.0% and 83.3% respectively. Cats were sacrificed 21 days after H. felis inoculation, and gastric tissues were homogenized. All gastric biopsy specimens were positive based on a rapid urease test (RUT) (6/6, 100%) and PCR (6/6, 100%). Based on these results, the HpSA kit is useful and effective for monitoring H. felis infection using stool specimens. If an HpSA test could be made with H. felis antibodies in the future, its sensitivity could be increased further. Further, PCR assay could be successfully used to detect H. felis in stools. Application of this HpSA kit and PCR assay can be utilized as a non-invasive strategy to identify H. felis in cats.

Helicobacter pylori Stool Antigen in Asymptomatic Children in Lagos State, Nigeria.

Aim: Helicobacter pylori stool antigen (HpSAg) is associated with chronic antral gastritis and peptic ulceration among young children. The major transmission mechanism is most probably fecal-oral infection among children. Study Design: To study the prevalence and associated demographic variables among school children in Lagos, Nigeria. Place of Study: Alimosho and Ajeromi Local Government Areas of Lagos state, Nigeria between months March and September 2014 Methodology: Fecal samples of 185 apparently healthy children aged between 2 and 16 years were collected by randomized stratified sampling with respective constructive and informative questionnaire. Fecal samples were analysed for Helicobacter pylori Stool Antigen (HpSAg) using immunoassay test kit for HpSAg. Result: Of the 185 children surveyed, high rate of HpSAg fecal positivity was found among ages 5 to 7 (21.6%) with no association with age group (p=0.149,OR= 0.67, CI=0.142-0.156). Fecal positivity among household population reveal high rate of 49.3% among 6 to 7 number of people living together, significant rate of 44.1% was recorded among the artisan but no association with the number of the people living together (p=0.004, OR=0.0, CI= 0.003-0.040). Significant high positive rate of 46.5% was observed among population that never had water availability (p=0.013, OR=0.0; CI=0.010-0.015) and 73.5% prevalence rate was observed. There is significant association (p <0.05) between HpSAg positivity and closeness of their kitchen and water source while no relationship was observed with household population, constant availability of water, maternal educational level, weight and gender. Conclusion: Prevalence HpSAg among asymptomatic children is high in overcrowded households and in families with low socioeconomic standards.

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.

Clinical value of three kinds of helicobacter pylori detection methods / 重庆医学

Objective To discuss the clinical value of three kinds of helicobacter pylori (HP) detection methods and find out the appropriate method for clinical application of the HP detection .Methods A total of 109 patients received gastroscopy ,the efficacy of RUT ,13C-urea breath test(13C-UBT) and the immunoCard STAT helicobacter pylori stool antigen (HpSA) for detection of HP were compared .Results RUT positive rate of the two pieces of gastric mucosa (the gastric antrum and the gastric body) was 34 .86% ,higher than that of single piece of gastric mucosa (gastric antrum or stomach body ) and two pieces of gastric mucosa (stomach) ,the difference was statistically significant (P0 .05) .The diagnosis of HP infection was based on 13C-UBT ,the immunoCard STAT HpSA sensi-tivity ,specificity and accuracy were 86 .49% ,95 .83% ,92 .66% ,respectively ,which were higher than RUT .Conclusion Two pieces of gastric mucosa (the gastric antrum and the gastric body) materials is appropriate for clinical promotion RUT based solution . RUT ,13C-UBT and hpsas immune quick check card are all clinical detection of HP and reliable methods ,but hpsas immune quick check card is more suitable for clinical promotion .

Efficacy of Different Laboratory Tests to Diagnose Helicobacter pylori Infection.

Helicobacter pylori is a Gram negative bacteria which causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. There are a set of laboratory tests to diagnose H. pylori infection with a variable accuracy, they are divided into non-invasive tests and invasive tests. Non-invasive tests include serology, urea breath test (UBT) and stool antigen test (SAT). Invasive tests include rapid urease test (RUT), histology and culture. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and H. pylori laboratory of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009 to evaluate the efficacy of RUT, SAT and Culture as a diagnostic tool for H. pylori. Dyspeptic patients were collected from outpatient department of BSMMU. Out of 224 dyspeptic patients 149 patients had ulcers or erosions in the stomach or duodenum. Stool sample could be collected from 139 patients. RUT has sensitivity of 100%, specificity 80.28%, positive predictive value 85% and negative predictive value 100%. Regarding culture, sensitivity is 100%, specificity 94.37%, positive predictive value 95% and negative predictive value 100%. Stool antigen test has sensitivity 95.94%, specificity 92.31%,positive predictive value 93% and negative predictive value 95%.

Usefulness of a Helicobacter pylori stool antigen test for diagnosing H. pylori infected C57BL/6 mice / 한국실험동물학회지

Among several diagnostic tests, a Helicobacter pylori stool antigen (HpSA) test may offer a useful noninvasive method for diagnosing infection without sacrificing animals. In this study, male C57BL/6 mice (n=6) were infected with H. pylori ATCC 49503 (1x10(8) CFU/mouse) by intragastric inoculation three times at 2-day intervals, and H. pylori infected stool specimens were collected 1, 3, 5, 7, 14, 21 days after infection to assess reliability of the HpSA test. Five of six specimens were positive at 5-21 days after infection, and the sensitivity of the HpSA test was 83.33%. The presence of H. pylori infection was confirmed by the rapid urease test and genomic DNA polymerase chain reaction (PCR), and showed the same results as the HpSA. However, the rapid urease test and genomic DNA PCR are invasive tests and require animal sacrifice to detect H. pylori in gastric biopsy samples. We suggest that an HpSA test kit would be useful and effective for monitoring H. pylori in various laboratory animals, as H. pylori can be easily monitored without sacrificing animals.

The use of Helicobacter pylori stool antigen test for the diagnosis of Helicobacter pylori in Lagos, Nigeria / El uso del test de antígeno en heces para el diagnóstico de la infección por Helicobacter pylori en Lagos, Nigeria

OBJECTIVES: This study was carried out to screen the use of Helicobacter pylori stool antigen (HpSA) tests for diagnosis and monitoring of H pylori in Nigeria. METHODS: Seven hundred and forty participants were enrolled after informed consent was obtained, while 83 came back for a post-eradication test. The stool samples were taken from the patients at endoscopy and tested for HpSA. RESULTS: The proportion of patients that were positive at the pretest, 520 (70.3%) was significantly higher (Fisher's exact p = 0.001) than those positive at the post-test, 44 (53%). There was a significant difference (F = 4.106, p = 0.043) between the mean age of those that came for the pretest (40.0 ± 14.5 years) and those that came for the post-test, 43.6 ± 11.6 years. More males than females had the tendency to come back for a post-eradication test. CONCLUSION: Although potential bias was introduced during this study, HpSA using monoclonal antibody could still be used for diagnosis and monitoring of H pylori in Nigeria.

OBJETIVOS: Este estudio se llevó a cabo con el propósito de examinar el uso del test de antígeno en heces (HpSA) para el diagnóstico y monitoreo de Helicobacter pylori en Nigeria MÉTODO: Tras obtener su consentimiento informado, se enrolaron ciento cuarenta participantes, mientras que 83 regresaron para un test de post-erradicación. Las muestras de heces fueron tomadas de pacientes en endoscopia e investigadas en busca de HpSA. RESULTADOS: La proporción de pacientes que resultaron positivos en el test previo, 520 (70.3%) fue significativamente mayor (Test exacto de Fisher p = 0.001) que la de los que resultaron positivos en el test posterior, 44(53%). Hubo una diferencia significativa (F = 4.106, p = 0.043) entre la edad promedio de los que vinieron al test previo (40.0 ± 14.5 años) y la de aquellos que vinieron al test posterior, 43.6 ± 11.6 años. Más varones que hembras mostraron tendencia a regresar al test de post-erradicación. CONCLUSION: Aunque un sesgo potencial fue introducido en este estudio, HpSA con anticuerpos monoclonales podría todavía usarse para el diagnóstico y monitoreo de H pylori en Nigeria.

Validation of a rapid stool antigen test for diagnosis of Helicobacter pylori infection / Validação de teste rápido de antígeno fecal para diagnóstico de infecção por Helicobacter pylori

The aim of this study was to validate the rapid lateral flow Helicobacter pylori stool antigen test (One step H. pylori antigen test, ACON laboratories, San Diego, USA; Prime diagnostics, São Paulo), using 13C-Urea Breath Test as the gold standard for H. pylori infection diagnosis. A total of 98 consecutive patients, asymptomatic or dyspeptic, entered the study. Sixty-nine were women, with a mean age of 45.76 ± 14.59 years (14 to 79 years). In the H. pylori-positive group, the rapid stool antigen test detected H. pylori antigen in 44 of the 50 positive patients (sensitivity 88 percent; 95 percent CI: 75.7-95.5 percent), and six false-negative; and in the H. pylori-negative group 42 presented negative results (specificity 87.5 percent; 95 percent CI: 74.7-95.3 percent), and six false-positive, showing a substantial agreement (Kappa Index = 0.75; p < 0.0001; 95 percent CI: 0.6-0.9). Forty four of fifty patients that had positive stool antigen were H. pylori-positive, the PPV of the stool antigen test was 88 percent (95 percent CI: 75.7-95.5 percent), and 42 patients with negative stool antigen test were H. pylori-negative, the NPV of the stool antigen test was 87.5 percent (95 percent CI: 74.7-95.3 percent). We conclude that the lateral flow stool antigen test can be used as an alternative to breath test for H. pylori infection diagnosis especially in developing countries.

O objetivo desse trabalho foi avaliar o teste rápido de antígeno de H. pylori nas fezes (One step H. pylori antigen test, ACON laboratories, San Diego, USA; Prime diagnostics, São Paulo), usando teste respiratório com uréia marcada com 13C (TRU-13C), como padrão ouro. Noventa e oito pacientes assintomáticos ou com dispepsia participaram do estudo. Sessenta e nove eram mulheres; a média de idade dos pacientes foi de 45.76 ± 14.59 (14 a 79 anos). No grupo H. pylori positivo, o teste rápido detectou antígenos de H. pylori nas fezes em 44 dos 50 pacientes positivos (sensibilidade de 88 por cento; 95 por cento IC: 75.7-95.5 por cento), com seis falso-negativos; e no grupo H. pylori negativo, 42 apresentaram resultados negativos (especificidade de 87,5 por cento; 95 por cento IC: 74.7-95.3 por cento), com seis falso-positivos, mostrando concordância substancial (índice Kappa = 0.75; p < 0.0001; 95 por cento IC: 0.6-0.9). Quarenta e quatro dos 50 que tiveram teste de antígeno fecal positivo eram H. pylori positivos, sendo o VPP do teste 88 por cento (95 por cento IC: 75.7-95.5 por cento), e 42 pacientes com teste de antígeno fecal negativo eram H. pylori negativos, com VPN de 87,5 por cento (95 por cento IC: 74.7-95.3 por cento). Concluímos que o teste de antígeno fecal imunocromatográfico pode ser usado como alternativa ao teste respiratório para diagnóstico de infecção pelo H. pylori, principalmente em países em desenvolvimento.

Prevalence of Subjects at a High or Very High Risk of Gastric Cancer in Japan

BACKGROUND/AIMS: The presence of Helicobacter pylori (H. pylori) infection represents a high-risk state of gastric cancer, but the risk is even higher in gastric atrophy. H. pylori stool antigen (HpSA) and serum pepsinogen (PG) tests are useful tools for screening present infection and gastric atrophy, respectively. To determine the prevalence of subjects at a high risk (HpSA+ or PG+) or very high risk (PG+) of gastric cancer in Japan, we applied the two tests to a general population. METHODS: The subjects included 311 volunteers. We used Meridian HpSA ELISA for the HpSA test and Pepsinogen RIA Beads for the PG test. PG I at 50% of those older than 40 years). Half of the subjects older than 60 years were PG+. CONCLUSIONS: In Japan, more than 50% of general population aged > or =40 years is at a high risk of gastric cancer, and half of the population aged > or =60 years is at a very high risk.