Detecção de Giardia intestinalis pelo teste de impressão duodenal e infecção por Helicobacter pylori em crianças e adolescentes com sintomas digestivos / Giardia intestinalis detected by biopsy imprint and Helicobacter pylori infection in dyspeptic children and adolescents

Objetivo: avaliar a relação entre a infecção por helicobacter pylori e a presença de giardia intestinalis, diagnosticada através do teste de impressão da mucosa duodenal em pacientes com dor abdominal. Material e métodos: foram avaliados prospectivamente 33 pacientes consecutivos com queixa de dor abdominal e que realizaram exame parasitológico de fezes; durante a endoscopia digestiva alta foram coletadas biópsias de duodeno para o teste de impressão e análise microscópica, e de mucosa do antro para pesquisa do H. pylori (teste rápido da urease e histologia). Resultados: o teste da impressão da mucosa duodenal foi positiva para giardia intestinalis em 9/33 pacientes (27,2%) e o H. pylori foi detectado em 21/33 (63,6%) pacientes, sendo 4/9 (44,4%) entre os pacientes infestados e 17/24 (70,8%) entre os não infestados por Giardia intestinalis. O exame parasitológico de fezes foi positivo em apenas 1/9 (11%) pacientes com o teste de impressão positivo; outros 3 pacientes apresentaram: ascaris lumbricoides, entamoeba coli e endolimax nana e a biópsia duodenal para giardia intestinalis foi positiva em 3/8 (37,5%). Conclusão: nossos resultados sugerem que não há associação entre parasitoses e infecção por Helicobacter pylori, sendo o teste de impressão da mucosa duodenal útil no diagnóstico da infestação por Giardia intestinalis durante investigação de pacientes com sintomas dispépticos submetidos à endoscopia digestiva. No entanto, são necessários mais estudos com maior amostragem.

Objective: to evaluate the relationship between helicobacter pylori infection and giardia intestinalis infestation, diagnosed by duodenal imprint test, in patients with abdominal pain. Material and methods: thirty three consecutive patients were prospectively evaluated by esophagogastroduodenoscopy and stool examination for ova and parasites. Duodenal biopsy was collected for imprint test and histological examination. H. pylori was diagnosed by histological examination of gastric antrum and rapid urease test. Results: duodenal imprint test was positive for giardia intestinalis in 9/33 patients (27.2%) and H. ylori was detected in 21/33 (63.6%) patients, 4/9 (44.4%) giardia intestinalis positive patients and 17/24 (70.8%) giardia intestinalis negative patients. Stool examination was positive in 1/9 (11%) patient with a positive duodenal imprint test, and another 3 patients presented ascaris lumbricoides, entamoeba coli e endolimax nana. Duodenal histology was positive for giardia intestinalis in 3/8 (37,5%). Conclusion: our results suggested that there is no association between giardiasis and Helicobacter pylori infection. Duodenal imprint test was useful to diagnose giardia intestinalis infestation in dyspeptic patients evaluated by esophagogastroduodenoscopy. Nevertheless, more studies with greater sampling are necessary.

Evaluation of invasive and non-invasive methods for the diagnosis of Helicobacter pylori infection in symptomatic children and adolescents

CONTEXT: Multiple diagnostic methods are available for the detection of Helicobacter pylori infection, but at present no single one can be used as the gold standard. OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of 3 invasive and 2 non-invasive methods for detection of Helicobacter pylori infection in symptomatic children and adolescents. DESIGN: Prospective cohort study SETTING: Peptic Disease outpatients service, Discipline of Pediatric Gastroenterology, Universidade Federal de São Paulo / Escola Paulista de Medicina. PATIENTS: Forty-seven patients who underwent endoscopy because of dyspeptic symptoms. DIAGNOSTIC METHODS: Endoscopy with gastric biopsies for 3 invasive (rapid urease test, histology and culture) and 2 non-invasive methods (a commercial ELISA serology and 13carbon urea breath test - isotope ratio mass spectrometry) for detection of Helicobacter pylori infection. MAIN MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values of each method and agreement and disagreement rates between the methods. RESULTS: Forty-seven patients [mean age, 11y9mo (SD 2y10mo), 27 female and 20 male]; 62 percent of them were Helicobacter pylori-positive. All methods agreed in 61 percent, and were negative in 21 percent and positive in 40 percent. The greatest concordance between 2 methods occurred between the invasive methods: histology and rapid urease test (89.6 percent) and histology and culture (87.5 percent). The greatest sensitivity, considering Helicobacter pylori-positive cases, for any combination of 3 or more tests, was achieved by the rapid urease test (S=100 percent), followed by histology, serology and 13carbon-urea breath test (S=93.1 percent) and lastly by culture (S=79.3 percent). The highest specificity was obtained by histology (100 percent) and culture (100 percent), followed by the rapid urease test (84.2 percent), serology (78.9 percent) and 13carbon-urea breath test (78.9 percent). CONCLUSIONS: Our results suggest that among invasive methods, an association between the rapid urease test and histology constituted the best choice for the detection of Helicobacter pylori infection. If results of histology and the rapid urease test are different, serology may be recommended