Aplicación de la serología para confirmar la erradicación de helicobacter pylori en pacientes con úlcera péptica / Serological asssessment of helicobacter pylori eradication in peptic ulcer patients

Background: Measurement of changes in serum antibodies is an excellent predictor of Helicobacter pylori eradication after antibiotic treatment. Aim: To measure the changes in serum antibody titers to Helicobacter pylori, before and after treatment. Material and methods: IgG antibodies to H. pylori were prospectively evaluated in 107 duodenal ulcer patients treated either with antibiotics (amoxicillin, metronidazole and bismuth subsalicylate) plus omeprazole or omeprazole alone. IgG antibody levels were determined using an "in house" ELISA in sera from 49 eradicated patients that received quadruple therapy and 58 non-eradicated patients (12 in whom antibiotic therapy failed and 46 that received omeprazole alone). Endoscopy, urease test, microscopy, and culture of gastric biopsies confirmed H. pylori eradication. Results: Patients in whom H. pylori was eradicated, showed a maintained drop in serum antibody titers that ranged from 15 percent, 62 percent, 74 percent to 76 percent at 28 days, 4, 8 and 12 months respectively. Such reduction was not observed in patients treated with omeprazole. Patients, in whom quadruple therapy failed to eradicate H. pylori, showed a discrete and transient decrease in antibody titers. By the fourth month, patients in whom eradication with quadruple therapy was not achieved, irrespective of whether they received quadruple therapy or omeprazole alone. Conclusions: A 45 percent decrease in IgG titer after 4 months is indicative of therapeutic success in H. pylori eradication. Therefore, serology may be useful to monitor the outcome of antibiotic therapy

Estudio prospectivo de erradicación de helicobacter pylori en ulcerosos duodenales: análisis de biopsias de antro y cuerpo gástrico / Prospective study of helicobacter pylori erradication in duodenal ulcer patients: analysis of antral and gastric body biopsies

Omeprazole may not eradicate helicobacter pylori from the stomach but rather displace it from the antrum to the stomach body. This fact could interfere with colonization studies in patients receiving the drug. The aim of this study was to assess the presence of helicobacter pylori, defined as a positive wrease test, culture or microscopical examination, in antral and gastric body biopsies in patients receiving treatment with omeprazole. Sixty four paired antral and gastric body biopsies obtained at the end of a 28 day course of omeprazole, 62 obtained 4 months later, 40 obtained 8 months later and 23 obtained 12 months later were analized. there was a 92 percent concordance between antral and gastric body biopsies for the presence of helicobacter pylori. However, 9 of the samples obtained at 28 days (14 percent) were negative for H. pylori in the antrum but positive in the gastric body. It is concluded that for early assessment of helicobacter pylori eradication after omeprazole treatment, paired biopsies of antral and gastric body are needed

Respuesta de anticuerpos IgG en pacientes colonizados por helicobacter pylori / Antibodies to helicobacter pylori in colonized patients with gastric symptoms and in asymptomatic groups

The IgG antibody response specific to Helicobacter pylori was evaluated through ELISA in a group of 92 gastric patients colonized by this bacteria. 74 had gastritis and 19 gastroduodenal ulcer. Three control groups were studied in a similary way: normal adult volunteers (n=17), adults with E coli or S typhi bacteremia (n=30) and normal infants (n = 30). IgG antibody response to H pylori was demonstrated in 98% of colonized patients and 0% of infants. Asymptomatic individuals and those with bacteremia had high rates of antibody response (76 and 90% respectively), although this rate and also the titers of antibody response were significantly lower than that of colonized patients (p < 0.05). ELISA reactive sera from colonized patients and asymptomatic individuals evidenced a similar antibody pattern when tested by blotting. This profile was absent in non reactive sera, including those with high antibody titers to C jejuni. The presence of specific IgG antibodies to H pylory in the majority of colonized gastric patients and asymptomatic adults suggest that this infection is very common in our population