Incidence and management of acid peptic disorders in sickle cell disease patients in Western Odisha

Background: Sickle cell disease (SCD) is a chronic hemolytic disorder characterized by the presence of crescent-shaped red blood cells. Abdominal pain is the common presenting symptom in adults with SCD. Among the patients who are not in crisis, it is estimated that one third of patients with homozygous SCD with chronic recurrent epigastric pain has endoscopic evidence of peptic ulcer disease. Aims and Objectives: This study was undertaken with an aim to analyze the incidence and management of acid peptic disorders among SCD patients in Western Odisha. Materials and Methods: A prospective study was done considering 88 homozygous SCD patients. All the patients underwent upper gastrointestinal endoscopy (UGIE) with gastric antral biopsy and rapid urease test (RUT). Cases with Helicobacter pylori were administered a 14 days course of three drug regimen of anti H. pylori drugs and followed-up to 6 weeks of beginning the treatment with repeat UGIE and RUT. Results: Out of 88 cases, 19 cases had duodenal ulcer (21.6%) which was significantly high than patients with gastric ulcer (13.6%). Other findings were gastroesophageal reflux disease and gastritis. About 93.5% of patients became RUT negative after taking anti H. pylori medication. Conclusion: SCD patients with acid peptic disorder constitute a sizeable proportion of patients attending surgical outpatient department and indoor department of surgery. Conservative treatment with life style modification can effectively improve the symptoms of acid peptic disease.

Detection of helicobacter pylori infection by helicobacter pylori IgG serology test in pediatric patients at the Philippine General Hospital

Objective@#To determine the validity of serum H. pylori IgG in the detection of H. pylori-associated gastroduodenitis in patients with gastrointestinal symptoms. @*Methods@#Cross-sectional study which included consecutive patients 1-18 years old with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy. H. pylori infection was diagnosed by positive tests for both rapid urease test (RUT) and Giemsa stain of gastric biopsies. H. pylori IgG (ELISA) serology was also performed.@*Results@#Twenty-five patients [Mean (SD) age: 12 (4.5) years, 68% females] were included. Majority presented with epigastric pain (64%) and had endoscopic gastritis (84%). Four patients had ulcers (1 antral, 3 duodenal). Giemsa stain was positive in 16 (64%) patients and RUT in one. Prevalence of H. pylori infection was 4%. Serum H. pylori IgG test was positive in two; borderline in three with a 100% sensitivity, 80% specificity, and a positive and negative likelihood ratio of 10.9 and 0.6.@*Conclusion@#The present study showed a low prevalence of H. pylori infection, thus, the validity of the H. pylori serology could not be adequately evaluated. We presently could not recommend the serum IgG in the detection of H. pylori gastroduodenitis in our setting.

Combined rapid urease test and histology for the diagnosis of helicobacter pylori infection

Significance@#Accurate detection of Helicobacter pylori (HP) is essential for the diagnosis of HP infection. The use of antibiotics and proton pump inhibitors (PPI) may result in false-negative rapid urease test (RUT) results. We aimed to determine the sensitivity and specificity of RUT compared with histology and assess the detection rate of combined RUT and histology for HP infection. @*Methodology@#Retrospective data collection was performed on 192 patients who were tested for both RUT and histology at the time of upper endoscopy from 2017 to 2018. At least two gastric biopsies (1 from corpus, 1 from antrum) were taken each for RUT and histology. The endoscopy was performed by a single gastroenterologist and a single pathologist was responsible for interpreting the histology with hematoxylin and eosin (H&E) and Giemsa stain. The gold standard test for the diagnosis of HP infection was histology. Demographic profile, RUT and histology results were reviewed. Tests for diagnostic accuracy were computed using SPSSv23. @*Results@#192 patients were tested for RUT and histology. 52(27.1%) were males and 140(72.9%) were females with a mean age of 54±17 years. Epigastric pain was the most common indication (42.7%). 24(12.5%) patients tested positive for HP infection. Among these; 16(8.3%) tested positive for both RUT and histology(true-positive), while 8(4.2%) tested negative for RUT but had positive histology(false-negative). 6 out of 8(75%) patients with false negative results had PPI use. The sensitivity and specificity of RUT for the diagnosis of HP infection were 66.7 and 98.2%, respectively. While the positive and negative likelihood ratio were 37.3 and 0.34, respectively with a diagnostic odds ratio of 110. @*Conclusion@#The HP detection rate of RUT combined with histology increased by 33% compared with RUT alone. RUT is a highly specific test for diagnosing HP infection. Given its modest sensitivity, histology plays an important role in the diagnosis of HP infection, especially in patients taking PPIs. We recommend doing histology when RUT is negative to increase the HP detection rate.

Adaptación a la realidad de Latinoamérica de la Guía Clínica NASPGHAN/ESPGHAN 2016 sobre Diagnóstico, Prevención y Tratamiento de Infección por Helicobacter pylori en Pediatría / Adaptation to the reality of Latin America of the NASPGHAN/ESPGHAN 2016 Guidelines on the Diagnosis, Prevention and Treatment of Helicobacter pylori Infection in Pediatrics

Resumen: Introducción: Las últimas guías clínicas conjuntas de NASPGHAN y ESPGHAN en relación a la infección por H. pylori publicadas el año 2016, contienen 20 afirmaciones que han sido cuestionadas en la práctica respecto a su aplicabilidad en Latinoamérica (LA); en particular en relación a la preven ción del cáncer gástrico. Métodos: Se realizó un análisis crítico de la literatura, con especial énfasis en datos de LA y se estableció el nivel de evidencia y nivel de recomendación de las afirmaciones mas controversiales de las Guías Conjuntas. Se realizaron 2 rondas de votación de acuerdo a la técnica Delfi de consenso y se utilizó escala de Likert (de 0 a 4) para establecer el "grado de acuerdo" entre un grupo de expertos de SLAGHNP. Resultados: Existen pocos estudios en relación a diagnóstico, efectividad de tratamiento y susceptibilidad a antibióticos de H. pylori en pacientes pediátricos de LA. En base a estos estudios, extrapolaciones de estudios de adultos y la experiencia clínica del panel de expertos participantes, se realizan las siguientes recomendaciones. Recomendamos la toma de biopsias para test rápido de ureasa e histología (y muestras para cultivo o técnicas moleculares, cuando estén disponibles) durante la endoscopia digestiva alta sólo si en caso de confirmar la infección por H. pylori, se indicará tratamiento de erradicación. Recomendamos que centros regionales seleccio nados realicen estudios de sensibilidad/resistencia antimicrobiana para H. pylori y así actúen como centros de referencia para toda LA. En caso de falla de erradicación de H. pylori con tratamiento de primera línea, recomendamos tratamiento empírico con terapia cuádruple con inhibidor de bomba de protones, amoxicilina, metronidazol y bismuto por 14 días. En caso de falla de erradicación con el esquema de segunda línea, se recomienda indicar un tratamiento individualizado considerando la edad del paciente, el esquema indicado previamente y la sensibilidad antibiótica de la cepa, lo que implica realizar una nueva endoscopía con extracción de muestra para cultivo y antibiograma o es tudio molecular de resistencia. En niños sintomáticos referidos a endoscopía que tengan antecedente de familiar de primer o segundo grado con cáncer gástrico, se recomienda considerar la búsqueda de H. pylori mediante técnica directa durante la endoscopia (y erradicarlo cuando es detectado). Con clusiones: La evidencia apoya mayoritariamente los conceptos generales de las Guías NASPGHAN/ ESPGHAN 2016, pero es necesario adaptarlas a la realidad de LA, con énfasis en el desarrollo de centros regionales para el estudio de sensibilidad a antibióticos y mejorar la correcta selección del tratamiento de erradicación. En niños sintomáticos con antecedente familiar de primer o segundo grado de cáncer gástrico, se debe considerar la búsqueda y erradicación de H. pylori.

Abstract: Introduction: The latest joint H. pylori NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conduc ted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the "degree of agreement" among a panel of SLAGHNP ex perts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylori in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recom mendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylori infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxi cillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the pa tient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or se cond degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.

Prevalence of Helicobacter pylori infection in dyspeptic patients undergoing upper gastrointestinal endoscopy in a tertiary-care teaching hospital

Background: Helicobacter pylori infection is widely prevalent in the world especially in the developing countries. The common clinical presentation of this disease includes peptic and duodenal ulcer. A major post-infection complication of this disease is gastric carcinoma. The scope of this study was to determine the prevalence of active H. pylori infection in the local population by retrospective review of patient records, which can give a better picture of the current situation and estimate the at-risk population of gastric carcinoma. Objective of the study was to determine the prevalence of H. pylori infection in biopsy specimens obtained from upper gastrointestinal endoscopy performed in dyspeptic patients in a tertiary-care hospital.Methods: The study was performed as a retrospective review of biopsy reports of 262 dyspeptic patients with previously unknown H. pylori status who underwent upper gastrointestinal endoscopy during the months of January 2018 to May 2018. Biopsy obtained from stomach was evaluated for the presence of H. pylori infection by Rapid Urease Test (RUT) or histopathological examination.Results: The prevalence of H. pylori infection in dyspeptic patients obtained from the above study was 44.7% and was found to be more common in males compared to females.Conclusions: H. pylori is a risk factor for gastric carcinoma. Determining the prevalence with early identification of active infections results in better treatment and post infection monitoring for malignancy.

Does H. pylori therapy augments the effect of iron therapy among children with iron deficiency anemia?

Background: To assess beneficial effects of H. pylori therapy on children with pre-existing Iron Deficiency Anemia (IDA).Methods: A total of 218 consecutive patients with iron deficiency anemia (Hb 6-11 gm/dl) were invited to participate in the study. Patients underwent endoscopic biopsy and rapid urease test for H. pylori detection. A total of three groups were formed- Group I (n=13) - positive for H. pylori, underwent treatment for H. pylori therapy and IDA, Group II (n=16) - positive for H. pylori, underwent treatment for IDA only, Group III (n=101) - negative for H. pylori, underwent treatment for IDA only. All the patients were followed up after every 4 weeks till week 12. Change in haematological parameters and anaemic and iron status was assessed. Chi-square paired 't'-test and ANOVA were used using SPSS 21.0.Results: All the 3 groups showed a significant increase in S. Hb, Ferritin and iron levels and a decrease in S. TIBC levels. At 12 weeks, mean S. ferritin and S. iron levels were significantly higher in Groups I and III as compared to Group II while Mean S. TIBC levels were significantly higher in Group II as compared to that in Groups I and II. A total of 73.3% of Group III, 53.8% of Group I and 56.3% of Group II patients had hemoglobin levels >11 g/dl, but difference was not significant (p=0.175).Conclusions: The findings of study showed that H. pylori therapy augments the effect of iron therapy among H. pylori positive children with iron deficiency anemia.

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.

Efficacies of Reverse Hybrid Therapy in Eradication of Helicobacter pylori Infection

Introduction: Because the prevalence of antibiotic resistancemarkedly increases with time worldwide, anti-H. pyloritreatment is continuing to be a great challenge for physiciansin clinical practice. Eradication of H. pylori infection markedlychanges the natural history of peptic ulcer in patients withduodenal or gastric ulcer. Most peptic ulcers associated withH. pylori infection are curable. Aim of present study was tostudy the efficacies of 14 days ‘ Reverse Hybrid Therapy’ inH.pylori positive G.I.patients.Material and methods: 100 H.pylori positive patients withupper G.I. complaints who underwent upper GI endoscopywere included in the study. H.pylori infection was documentedby at least 2 positive results of Rapid Urease Test. Subjectswith any of the following criteria were excluded from thestudy. 1. Previous eradication therapy 2. Allergy to anyantibiotic used in study. 3. Co- existence of any serious illness.4. Pregnancy or lactating women 5. Previous gastrectomy6. Use of antibiotics within last 4 week. Detailed medicalhistory and demographic details of the patients were recorded.Routine haematogical tests and USG was done. Patients weregiven 14 days dual therapy ie quadruple regimen (proton pumpinhibitor + amoxicillin + clarithromycin + metronidazole) forfirst 7 days followed by dual regimen of PPI+ amoxicillin fornext 7 days. Patients were asked to report at 7, 14 days and at6 weeks interval.Results: Out of 97 patients 93 patients became negative forH.pylori after 6 week of Reverse Hybrid eradication therapy.It was observed that majority of patients enrolled in the studywere in the age group of 41–60 years (50%) followed bybelow 40 yrs (27%), above 60 yrs (23%). Out of them, 74%were male and 26% were female.Conclusion: Out of 97 patients 93 patients became negativefor H.pylori after 6 week of Reverse Hybrid eradicationtherapy. Hence, Reverse Hybrid Therapy is equally potenttherapy to Bismuth based therapy though the latter has a lotof side effects.

Utility of Anti-Helicobacter pylori IgG Estimation in the Diagnosis of Acid Peptic Diseases: A Comparison of Serum IgG Level with Rapid Urease Test

Introduction: The mode of treatment of APD is changedradically ever since the role of H.pylori is proved for thiscondition. The study was aimed to detect the utility of antiH.pylori IgG estimation in the diagnosis of acid pepticdiseases.Material and methods: Endoscopic examination of stomachfollowed by Rapid Urease Test on the biopsy material andthe anti-Helicobacter pylori IgG quantitative estimation weredone in 85 patients with history suggestive of acid pepticdisease.Results: 46 (100%) patients with gastritis showed positiveRapid Urease Test within 30 minutes and had serum IgG >30IU/ml. 10 patients with peptic ulcer, 12 patients with non ulcerdyspepsia and 2 patients with carcinoma stomach gave positiveRapid Urease Test after 30minutes and serum IgG level was< 30 IU/ml for these patients. Of the 70 Rapid Urease Testpositive in the study, 2 of the 12 non ulcer dyspepsia patientswere negative for antibody. Endoscopy findings in 15 subjectswere normal and negative for Rapid Urease Test and antiHelicobacter pylori IgG antibody.Conclusion: Estimation of Serum anti-Helicobacter pyloriIgG may be useful as a non invasive method in the diagnosisof gastritis.

Incidence and profile of Helicobacter pylori infection among HIV positive patients

Background: People having HIV infection present with a number of symptoms related to gastrointestinal tract like dyspepsia. HIV itself as well as opportunistic infections is responsible for such symptoms. Notably is Helicobacter pylori infection causes variety of such symptoms. The objective of the present research was to study incidence and profile of Helicobacter pylori among HIV positive patients.Methods: A hospital based cross sectional study was carried out over a period of two years among 101 HIV positive patients in the Department of General Medicine, Madurai Medical College, Madurai in collaboration with Department of Medical Gastroenterology and also Department of Venereology and Leporology. Rapid urease test was done. HIV status was confirmed by ELISA test. Data was analysed with the help of EPI statistical software.Results: Majority (40.6%) had CD4 count of 200-500. It has been observed that incidence of Helicobacter pylori was low in groups with low CD4 count. It was also observed that those with higher CD4 count had higher incidence of RUT positivity. This association was found to be statistically significant. The incidence of Helicobacter pylori positivity was not significantly different among those patients who were on ART (18%) and those who were not on ART (21%).Conclusions: The incidence of Helicobacter pylori infection was less in HIV positive patients. Those with CD4 cell count less than 100 had lower incidence of Helicobacter pylori infection than those with CD 4 cell count more than 500. Incidence of Helicobacter pylori infection was not affected by ART.

Antibiotic resistance in Helicobacter pylori: A mutational analysis from a tertiary care hospital in Kashmir, India

Background: Helicobacter pylori infection is recognised as type 1 carcinogen by the International Agency of Research on Cancer. Previous studies in our hospital have revealed high prevalence of H. pylori in our population with a high recurrence rate after completion of treatment. This prompted us to undertake this study. Aim: This study aimed to determine common gene mutations leading to resistance to clarithromycin, metronidazole, tetracycline and quinolones in H. pylori in patients attending our hospital. Settings and Design: This is a cross-sectional hospital-based study. The study was approved by the Institutional Ethics Committee. Materials and Methods: This study was conducted on 196 adult dyspeptic patients with an indication for upper gastrointestinal endoscopy. Gastric biopsies collected from them were subjected to histopathological examination, rapid urease test (RUT) and culture. Of the 196 patients, 95 met the inclusion criteria. Drug susceptibility testing (DST) by various polymerase chain reaction-based methods was done for 47 RUT-positive biopsies and 13 H. pylori isolates. Results: Maximum resistance was seen to metronidazole (81.66%) followed by clarithromycin (45%) and quinolones (3.33%). No high-level resistance was seen to tetracycline. In clarithromycin-resistant cases, A2142G mutation was more prevalent than A2143G mutation. Multidrug resistance (resistance to metronidazole and clarithromycin) was seen in 41.66% of patients. Conclusions: Tetracycline and quinolones could be the antibiotics of choice in the eradication of H. pylori in this region, while recurrence of the infection with H. pylori could be expected among patients receiving either metronidazole or clarithromycin, for eradication therapy. DST should be done on a routine basis utilising both phenotypic and genotypic methods to prevent further emergence of resistance in this region.

Determinar la concordancia del test rápido de ureasa y de la histopatología para el diagnóstico de enfermedad gastroduodenal por Helicobacter pylori en pacientes pediátricos de 2 a 14 años atendidos en el Hospital del Niño de enero de 2001 a enero 2014 / Determine the concordance of the rapid urease test and the histopathology for the diagnosis of gastroduodenal disease by Helicobacter pylori in pediatric patients aged 2 to 14 years attended in the child's hospital from January 2001 to January 2014

Helicobacter pylori es una de las causas más frecuentes de infección bacteriana crónica. La epidemiología apunta a que la infección se adquiere en su gran mayoría durante la edad pediátrica. Métodos: Se realizó un estudio de concordancia de pruebas diagnósticas, analítico, ambispectivo, para evaluar la seguridad, validez y fuerza de concordancia del Test rápido de ureasa al compararlo con la histopatología para el diagnóstico de enfermedad gastroduodenal asociada a infección por Helicobacter pylori. Resultados: De un total de 93 pacientes se encontró que un 52 % eran de sexo masculino y 48 % de sexo femenino. De acuerdo a la edad 21% eran preescolares, 37% escolares y 42 % adolescentes. En un 89 % de los casos el dolor abdominal recurrente fue la indicación principal de endoscopía. De los pacientes participantes, 55 resultaron positivos por Enfermedad gastroduodenal por H. pylori (59.13 %) y 38 negativos (40.87 %).Con respecto a la concordancia entre la prueba de rápida de ureasa y la histopatología, κ = 0.502, considerada fuerza de concordancia moderada y p < 0.0001 indica que es estadísticamente significativa. Los escolares presentaron concordancia del Test de ureasa con la histopatología de 0.59 (moderada), p = 0.0003. La probabilidad diagnóstica aumenta a 9.29 (moderada), considerada una prueba buena en este grupo etario. En escolares y adolescentes, la nodularidad antral tiene una sensibilidad de 97.73% y un Valor predictivo negativo de 92.13%. Se observa que la concordancia es de 0.68, IC (0.49 ­ 0.86), p <0.0001 ) y 0.67 IC (0.45 ­ 0.88), p< 0.0001 en pacientes con densidad de colonización de moderada a severa (relación alta e incluso muy alta para los límites superiores de los intervalos de con anza).

Helicobacter pylori is one of the most common causes of chronic bacterial infection. Epidemiology suggests that the infection is acquired mostly during childhood. Methods:An agreement study of diagnostic, analytical, ambispective tests to assess the safety, validity and strength matching the rapid urease test when compared with histopathology for the diagnosis of gastroduodenal disease associated with infection by Helicobacter pylori was performed. Results: From a total of 93 patients found that 52% were male and 48% female. According to preschool age were 21%, 37% and 42% school adolescents. In 89% of cases recurrent abdominal pain was the main indication for endoscopy. Of the participating patients, 55 were positive for H. pylori peptic disease (59.13%) and 38 negative (40.87%). With regard to the correlation between rapid urease test and histopathology, κ = 0.502, considered force moderate concordance p <0.0001 indicates that it is statistically significant. School had urease test concordance with histopathology of 0.59 (moderate), p = 0.0003. The diagnostic probability increases to 9.29 (moderate), considered a good test in this age group. In children and adolescents, the antral nodularity has a sensitivity of 97.73% and a negative predictive value of 92.13%. It is observed that the correlation is 0.68, CI (0.49 to 0.86), p <0.0001) and CI 0.67 (from 0.45 to 0.88), p <0.0001 density in patients with moderate to severe colonization (high ratio too high for even the upper limits of the confidence intervals).

Investigation of Helicobacter pylori antigen in stool samples of patients with upper gastrointestinal complaints

Abstract Helicobacter pylori infection is usually acquired in early childhood and it can persist throughout life without antibiotic treatment. This study aimed to compare the accuracy of the noninvasive H. pylori Stool Antigen Test-applied on the stool samples with the invasive gold standart Rapid Urease Test-applied on the gastric biopy samples of patients with upper gastrointestinal complaints. After endoscopy, biopsy and stool specimens were taken in 122 patients. The infection was detected with rapid urease test which is accepted as gold standart test. Rapid, one-step H. pylori card test was applied to all patients stool specimens. In this study 106 of the 122 patients (86.8%) were positive for H. pylori infection, while 16 of the 122 patients (13.2%) were negative. H. pylori card test was negative in 13 of the 16 patients and was positive in 98 of the 106. The sensitivity, specifity, positive and negative predictive values were 92.45%, 81.25%, 97.02%, and 61.90%, respectively. H. pylori card test is rapid, easy, noninvasive and inexpensive methods for detection H. pylori infection. This test showed high sensitivity and specificity. Additionally, it may be a good alternative to invasive tests for the detection of H. pylori infections especially in children.

A comparative study on routine diagnostic methods in infection of Helicobacter pylori / 中华消化内镜杂志

Objective To investigate the efficacy of the four commonly used diagnostic methods in infection of Helicobacter pylori ( H. pylori ) . Methods The study included 133 patients with upper gastrointestinal symptoms. Three fresh gastric biopsy were extracted from the lesser curvature of antrum when patients accepting gastroscopy,for the rapid urease test( RUT) test strip, RUT gel method, and histological examination, respectively.14C?urease breath test(14C?UBT) was carried out 1 hour after the procedure. The result of histological examination was served as the golden reference.Any two tests positive were served as the relative golden reference. The diagnostic accuracy of the four methods and the consistence with golden reference and relative golden reference was evaluated. Results The positive results were obtained in 111 cases by RUT test strip,76 by RUT gel method, 70 by 14C?UBT,and 62 by Warthin—Starry stain. With Warthin—Starry positive as the golden reference, the finding of RUT test strip was poorly consistent with the result of Warthin—Starry(Kappa=0?295).However, the findings of RUT gel method and 14C?UBT were highly consistent with the result of Warthin—Starry( Kappa=0?672,0?670) . Because of the poor specificity of RUT test strip, any two positive tests from Warthin—Starry,RUT gel method and 14 C?UBT were used as the relative golden reference to evaluate the diagnostic accuracy. The findings of Warthin—Starry and 14 C?UBT were perfectly consistent with the golden reference( Kappa=0?821,0?850) , and the finding of RUT gel method was highly consistent with the golden reference(Kappa=0?763). However, the finding of RUT test strip was poorly consistent with golden reference(Kappa=0?280).When the delta cutoff value for the UBT was calculated as a standard value(DMP≥100),the area under the ROC curve was 0?932 (0?884?0?979) , and the sensitivity, specificity and accuracy of 14 C?UBT were 100?0%, 86?3% and 92?5%, respectively.When the delta cutoff value for the UBT was recalculated as a new value(DMP≥166),the area under the ROC curve increased to 0?949(0?906?0?992).With the golden reference as the evaluation, the sensitivity, specificity and accuracy of UBT test were 96?7%, 93?2% and 94?7%, respectively. Conclusion RUT test strip shows low accuracy; RUT gel method,UBT and histological examination have high accuracy and similar efficacy. When the delta cutoff value for the test is recalculated as DMP≥166, the accuracy of the test can be improved.

Validación de Sensibacter pylori test® como prueba de ureasa para el diagnóstico de infección por Helicobacter pylori en Chile / Validation of Sensibacter pylori test ® as urease tests for the diagnosis of Helicobacter pylori infection in Chile

Introduction: Helicobacter pylori is a highly prevalent bacterium in Chile that causes various gastric pathologies including gastric cancer, which corresponds to the leading cause of cancer-related death in Chile in men. This is why early detection of an Helicobacter pylori infection is gaining importance, for tis purpose there are various diagnostic methods, including rapid urease tests (RUT) such as the Sensibacter pylori test®. Objectives: To validate the Sensibacter pylori test® in Chile, so that it may be used in healthcare centres in our country. Materials and Methods: Upper gastrointestinal endoscopies were performed on symptomatic patients in 3 healthcare centres and gastric mucosa samples were obtained following established protocols. These underwent the health centre ́s RUT and the Sensibacter pylori test®, and the results were compared to the gastric mucosa histology (gold standard) Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each test. Kappa test was used to assess agreement between the RUT’s and the turning time of each test was measured. Results: Sensibacter pylori test® showed a sensitivity of 82.6 percent, specificity 92.3 percent, PPV 95 percent and NPV 75 percent. The consistency with the other RUT’s was 0.958 (p < 0.001) and 0.872 (p < 0.001). The turning time was 15 min. Conclusion: Sensibacter pylori test® is a sensitive and specific method, similar to other tests used daily in Chile, which has the advantage of yielding results within a few minutes.

Introducción: Helicobacter pylori es una bacteria de gran prevalencia en Chile y es causante de variadas patologías gástricas, entre las cuales se encuentra el cáncer gástrico, que corresponde a la primera causa de muerte por cáncer en Chile en hombres. Por esto, cobra relevancia detectar a tiempo la existencia de Helicobacter pylori, para lo cual existen diversos métodos diagnósticos, entre los que se encuentran los test rápidos de ureasa (TRU) como Sensibacter pylori test®. Objetivos: Validar Sensibacter pylori test® en Chile, para poder ser utilizado en centros de salud de nuestro país. Materiales y Métodos:Se realizaron endoscopias digestivas altas a pacientes sintomáticos en tres centros de salud y se obtuvieron muestras de mucosa gástrica según protocolos establecidos. Estas se sometieron al TRU del centro de salud y a Sensibacter pylori test®, comparándose el resultado con histología de la mucosa gástrica (estándar de oro), calculándose sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Se utilizó test kappapara evaluar concordancia entre TRU y se midió el tiempo de viraje de cada test. Resultados: Sensibacter pylori test® demostró una sensibilidad de 82,6 por ciento, especificidad de 92,3 por ciento, VPP de 95 por ciento y VPN de 75 por ciento. La concordancia con los otros TRUs fue de 0,958 (p < 0,001) y 0,872 (p < 0,001). El tiempo de viraje fue de 15 min. Conclusión: Sensibacter pylori test® es un método sensible y específico comparable con otros test de uso diario en Chile, y tiene la ventaja de mostrar resultados en pocos minutos.

Comparison between rapid urease test and carbon 14 urea breath test in the diagnosis of Helicobacter pylori infection.

Background: The most common human infection of upper gastrointestinal region is Helicobacter pylori. Most individuals remain asymptomatic due to misuse of antibiotic and proton pump inhibitors. Methods: 50 patients admitted or on outpatient department basis were selected based on the upper gastrointestinal symptoms and whether they were 18 years and above. Results: The Rapid Urease Test (RUT) had 84% sensitivity and 91% specificity, with an overall accuracy of 88%. The results of the Urea breath Test (UBT) showed 88% sensitivity and 83% specificity, and an overall accuracy of 85%. Conclusions: The invasive procedure OGD scopy need not be done in patients for the sole purpose of diagnosing HP infection as the diagnostic efficacies of RUT & UBT tests are similar.

Helicobacter Pylori Eradication Therapy in both Erosive and Non-erosive Gastritis — A Prospective Study.

Background: Infection with Helicobacter pylori (H. pylori) is a recognized cause of peptic ulcer and gastritis. Persistence of infection is a definite risk factor for gastric malignancy. Healing of gastritis after eradication of H. pylori reduces the risks of peptic ulcer disease and gastric malignancy. Objectives: To find out the relationship of H. pylori with erosive and nonerosive gastritis, the effect of anti-H. pylori therapy and to compare the effects of anti-H. pylori therapy between two types of gastritis. Materials and Methods: This prospective study was done in the Gastroenterology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from June 2008 to May 2009. One hundred eighty dyspeptic patients were enrolled for the study. Patients with gastritis diagnosed by endoscopy underwent rapid urease test (RUT). RUT positive patients were considered to have H. pylori infection and were treated with triple therapy (omeprazole, amoxycillin and metronidiazole) for 14 days. Treatment responses were assessed by clinical history and also by endoscopic biopsy and RUT. Results of endoscopic findings and RUT after treatment were compared with pretreatment status. Results: Seventy patients completed the treatment and finally could be assessed. Endoscopic findings of 70 patients revealed that 56 (80%) patients had erosive gastritis and 14 (20%) patients had nonerosive gastritis. After treatment, 47 (67.1%) lesions became normal, 16 (22.9%) remained erosive and 7 (10%) non-erosive as before. Out of 14 non-erosive diseases, 7 became normal, while out of 56 erosive diseases 40 became normal. The erosive group responded significantly better than the non-erosive group (c2=32.766, p<0.001). Fifty nine (84.3%) patients with gastritis showed negative urease test after treatment. Conclusion: Strong relation between H. pylori infection and gastritis was found. Majority were antral erosive gastritis. Erosive group responded better than non-erosive group.

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%.

United Rapid Urease Test Is Superior than Separate Test in Detecting Helicobacter pylori at the Gastric Antrum and Body Specimens

BACKGROUND/AIMS: The rapid urease test (RUT) is an invasive method to diagnose Helicobacter pylori infection, which relies on the acquisition and examination of gastric antrum and body tissues. We determined and compared the efficacy of RUT when the tissues were examined separately or after being combined. METHODS: Two hundred and fourteen patients were included and underwent esophagogastroduodenoscopy from July 2008 to June 2010. The separate test was defined as evaluating the status of infectivity of H. pylori from the antrum and body separately; whereas the united test was carried out putting both tissues from the antrum and body in the same RUT kit. All RUTs were read by a single observer 1, 3, 6, 12, and up to 24 hours later. We also got two biopsy specimens stained with hematoxylin and eosin and quantified H. pylori density was calculated on a scale of 0 to 3. RESULTS: Overall positivity for H. pylori was 137 (64%) for the separate test and 148 (69.2%) for the united test (p<0.01). The mean time to a positive test was 3.58 hours for the separate test and 1.69 hours for the united test (p<0.01). The correlation between the time to positive RUT and the severity of histology showed r=+0.556 for the antrum (p<0.01) and r=+0.622 for the body (p<0.01). CONCLUSIONS: Combining tissues prior to RUT enhances the detection of H. pylori, as compared with the examination of separate tissues, and shortens the time to develop a positive reaction by approximately 50%. These diagnostic advantages are also accompanied by increased cost-savings.