Acurácia diagnóstica entre teste rápido da urease e estudo histopatológico para detecção de Helicobacter pylori / Diagnostic accuracy of urease quick test compared to histopathological study for Helicobacter pylori detection

Objetivo: Analisar a acurácia do teste rápido da urease para detecção de Helicobacter pylori comparado com o exame histopatológico. Métodos: Estudo prospectivo e descritivo realizado de abril de 2018 a maio de 2019 em um Serviço de Endoscopia e Biliopancreática e em um laboratório de patologia. A amostra foi composta de 64 pacientes, de ambos os sexos, com idade de 35 a 81 anos, que apresentavam queixas dispépticas. Foram realizados exame histopatológico e teste rápido da urease. Os dados foram analisados pelo R Core team 2019 e submetidos a análises descritivas (variáveis categóricas) e inferenciais (teste de associação de qui-quadrado de Pearson e teste de Mann-Whitney). O nível de significância adotado foi de 5%. Resultados: O teste rápido da urease demonstrou que dez pacientes foram verdadeiros-positivos, 39 verdadeiros-negativos, três falsos-positivos, 12 falsos-negativos, com sensibilidade de 45,4% (25,1% a 67,3%), especificidade de 92,9% (79,4% a 98,1%), valor preditivo positivo de 76,9% (45,9% a 93,8%), valor preditivo negativo de 76,5% (62,2% a 86,7%), acurácia de 76,6% (64,0% a 85,9%), razão de chance diagnóstica 10,8 (2,56 a 45,9), índice de Youden 0,38 (0,16 a 0,60) e taxa de erro de 23,4% (14,1% a 36,0%). Conclusão: O teste rápido da urease apresentou baixa capacidade de detectar pacientes infectados, menor acurácia em relação ao estudo anatomopatológico e alta especificidade. O teste pode ser útil no momento da realização da endoscopia, por fornecer resultado rápido e barato para detectar H. pylori. O diagnóstico da bactéria apresenta maior confiabilidade com a realização dos dois métodos para pesquisa de H. pylori.

Objective: To analyze the accuracy of the rapid urease test for Helicobacter pylori detection when compared with the histopathological examination. Methods: This is a prospective and descriptive study conducted from April 2018 to May 2019, at an Endoscopy and Biliopancreatic Service and in a pathology laboratory. The sample consisted of 64 male and female patients aged 35 to 81 years old with dyspeptic complaints. Histopathological examination and rapid urease test were performed. Data were analyzed by R Corel team 2019 and underwent descriptive (categorical variables) and inferential (Pearson's Chi-squared association test and Mann-Whitney test) analyzes. The significance level adopted was 5%. Results: The rapid urease test showed that ten patients were true positive, 39 true negative, three false-positive, and 12 false-negative, and sensitivity was of 45.4% (25.1% to 67.3%), specificity 92.9% (79.4% to 98.1), positive predictive value of 76.9% (45.9-93.8%), negative predictive value of 76.5% (62.2% to 86.7%), accuracy of 76.6% (64.0% to 85.9%), diagnostic odds ratio of 10.8 (2.56% to 45.9), Youden index 0.38 (0.38% to 0.60), and error rate 23.4 (14.1% to 36.0%). Conclusion: The rapid urease test showed low ability to detect infected patients, lower accuracy compared to the pathological study, and high specificity. The test may be useful at the time of endoscopy, as it provides a quick and inexpensive result to detect H. pylori. The diagnosis of the bacterium is more reliable when both methods for H. pylori investigation are performed

Gênero, idade, achados endoscópicos, urease e Helicobacter pylori: ausência de correlação dentro de uma amostra de população com alta prevalência de câncer gástrico na Amazônia / Gender, age, endoscopic findings, urease and helicobacter pylori: all uncorrelated within a sample of a high gastric cancer prevalence population in amazon

ABSTRACT BACKGROUND: It is widely assumed that gender, age, gastritis and Helicobacter pylori , all have some degree of correlation and, therefore, can synergistically lead to the development of gastric cancer. OBJECTIVE: In this cross-sectional study, we expected to observe the above mentioned correlation in the analysis of medical records of 67 patients of both sexes (female, n=44), mean age ± standard deviation: 41±12 years old, all from Belém (capital of Pará State, Brazilian Amazon), a city historically known as one with the highest gastric cancer prevalence in this country. METHODS: All patients were submitted to upper gastrointestinal endoscopy for gastric biopsy histopathological analysis and rapid urease test. All diagnoses of gastritis were recorded considering its topography, category and the degree of inflammatory activity, being associated or not associated with H. pylori infection. RESULTS: The results show that no statistically relevant associations were found among the prevalences of the observed variables. CONCLUSION: The authors hypothesize that observed risk factors associated to gastric cancer might be lesser synergistic than is usually expected.

RESUMO CONTEXTO: É amplamente assumido que gênero, idade, gastrite e Helicobacter pylori , todos têm algum grau de correlação e, portanto, podem sinergicamente levar ao desenvolvimento de câncer gástrico. OBJETIVO: Neste estudo transversal, esperamos observar a correlação acima mencionada na análise de prontuários de 67 pacientes de ambos os sexos (sexo feminino, n=44), média de idade ± desvio padrão: 41±12 anos, todos de Belém (capital do Estado do Pará, Amazônia Brasileira), uma cidade historicamente conhecida como sendo uma das que apresenta maior prevalência de câncer gástrico no país. MÉTODOS: Todos os pacientes foram submetidos à endoscopia digestiva alta para análise histopatológica da biópsia gástrica e teste rápido da urease. Todos os diagnósticos de gastrite foram registrados considerando sua topografia, categoria e grau de atividade inflamatória, sendo associada ou não associada à infecção por H. pylori . RESULTADOS: Os resultados mostram que não foram encontradas associações estatisticamente relevantes entre as prevalências das variáveis observadas. CONCLUSÃO: Os autores levantam a hipótese de que os fatores de risco associados ao câncer gástrico podem ser menos sinérgicos do que o esperado.

Tinea faciei on the right eyebrow caused by Trichophyton interdigitale

Abstract Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.

Comparison between Resectable Helicobacter pylori-Negative and -Positive Gastric Cancers

BACKGROUND/AIMS: Controversy exists regarding the characteristics of Helicobacter pylori infection-negative gastric cancer (HPIN-GC). The aim of this study was to evaluate clinicopathologic features of HPIN-GC compared to H. pylori infection-positive gastric cancer (HPIP-GC) using a comprehensive analysis that included genetic and environmental factors. METHODS: H. pylori infection status of 705 resectable gastric cancer patients was determined by the rapid urease test, testing for anti-H. pylori antibodies, histologic analysis and culture of gastric cancer tissue samples, and history of H. pylori eradication. HPIN-GC was defined as gastric cancer that was negative for H. pylori infection based on all five methods and that had no evidence of atrophy in histology or serology. RESULTS: The prevalence of HPIN-GC was 4% (28/705). No significant differences with respect to age, sex, smoking, drinking, family history of gastric cancer or obesity were observed between the two groups. HPIN-GC tumors were marginally more likely to involve the cardia (14.3% for HPIN-GC vs 5.3% for HPIP-GC, p=0.068). The Lauren classification, histology, and TNM stage did not differ according to H. pylori infection status. Microsatellite instability was not different between the two groups, but p53 overexpression in HPIN-GC was marginally higher than in HPIP-GC (56.0% for HPIN-GC vs 37.0% for HPIP-GC, p=0.055). CONCLUSIONS: The prevalence of HPIN-GC was extremely low, and its clinicopathologic characteristics were similar to HPIP-GC.

New monoclonal antibody-based test for Helicobacter pylori urease in gastric tissue

BACKGROUND/AIMS: To evaluate a new monoclonal antibody for Helicobacter pylori urease in gastric tissue. METHODS: A total of 107 volunteers were enrolled. All subjects underwent a 13C-urea breath test and esophagogastroduodenoscopy. Gastric aspirates were analyzed for pH and ammonia. Six biopsy specimens in the gastric antrum and body were obtained for a rapid urease test and histology. The new monoclonal antibody-based H. pylori urease test (HPU) was performed to rapidly and qualitatively detect urease in two biopsy specimens. RESULTS: H. pylori infection was diagnosed in 73 subjects. The sensitivity and specificity of the HPU was 89% and 74%, respectively. The subjects were divided into two groups: one with true-positive and true-negative HPU results (n = 90) and the other with false-positive and false-negative HPU results (n = 17). Across all subjects, ammonia levels were 900.5 +/- 646.7 and 604.3 +/- 594.3 mumol/L (p > 0.05), and pH was 3.37 +/- 1.64 and 2.82 +/- 1.51 (p > 0.05). Sensitivity was higher in the presence of atrophic gastritis or intestinal metaplasia. CONCLUSIONS: HPU detected H. pylori in approximately 10 min. Gastric aspirate ammonia and pH levels did not affect the test results. Sensitivity was good in the presence of atrophic gastritis or intestinal metaplasia.

Concordancia entre procedimientos diagnósticos invasivos para la infección por Helicobacter pylori en adultos / Concordance among invasive diagnostic procedures for Helicobacter pylori infection in adults

Objetivo. Comparar la concordancia entre cultivo, histología y prueba rápida de la ureasa para el diagnóstico de infección por Helicobacter pylori, así como la relación de hallazgos histopatológicos y frecuencia de positividad entre dichos procedimientos diagnósticos. Material y métodos. Estudio de pruebas diagnósticas. Población de sujetos con endoscopía digestiva y toma de muestras gástricas antrales en un hospital de especialidades en México. Se realizó prueba rápida de la ureasa (una muestra), histología (dos muestras) y cultivo (dos muestras). Análisis estadístico con coeficiente de Kappa. Resultados. Se estudiaron 108 sujetos: 28 (25.9%) hombres y 80 (74.1%) mujeres; la edad promedio fue 49.1 (DE 15.1) años. El coeficiente de Kappa fue 0.729 y 0.377 entre cultivo con histología y prueba rápida de la ureasa respectivamente; asimismo, el coeficiente de Kappa fue 0.565 entre histología y prueba rápida de la ureasa. Conclusiones. La fuerza de concordancia fue mayor entre histología con cultivo y la prueba rápida de la ureasa, por lo cual la histología es lo más recomendable en la práctica clínica para la detección de la infección por Helicobacter pylori.

Objective. Compare the strength of concordance between culture, histology, rapid urease test for diagnosis of Helicobacter pylori infection and histopathological findings relationship and frequency of positivity among such diagnostic procedures. Materials and methods. Diagnostic test study. The study population were subjects with endoscopy and take samples of gastric antral. Rapid urease test (one sample), histology (two samples) and culture (two samples), and histopathological findings of gastric mucosa were performed. Statistical design with Student's t, Fisher exact test, Kappa coefficient. Results. We reviewed 108 subjects, 28 (25.9%) men, 80 (74.1%) women, mean age was 49.1 years (SD 15.1). The Kappa coefficient was 0.729 and 0.377 between culture with histology and rapid urease test, respectively; likewise the Kappa coefficient was 0.565 between histology and rapid urease test. Conclusions. The strength of concordance was higher between histology with culture and rapid urease test; the most recommended being histology in clinical practice for the detection of Helicobacter pylori infection.

Alkali production in the mouth and its relationship with certain patient's characteristics

Objectives To assess the relationships among alkali production, diet, oral health behaviors, and oral hygiene. Methods Data from 52 subjects including demographics, diet, and oral hygiene scores were analyzed against the level of arginine and urea enzymes in plaque and saliva samples. An oral habit survey was completed that included: use of tobacco (TB), alcohol (AH), sugary drinks (SD), and diet. Alkali production through arginine deiminase (ADS) and urease activities were measured in smooth-surface supragingival dental plaque and un stimulated saliva samples from all subjects. ADS and urease activities were measured by quantification of the ammonia generated from the incubation of plaque or saliva samples. Spearman correlations were used to compute all associations. Results Participants in the lowest SES (Socio-economic status) group had the habit of consuming sugary drinks the most and had the highest rate of tobacco use. Males consumed significantly more alcohol than females. No significant relationship was found between age or gender and alkali production. Higher rates of sugary drink consumption and tobacco use were significantly related to lower alkali production. Conclusion The study showed a relationship between alkali production and oral hygiene, diet, and certain oral health behaviors. Poor oral hygiene was significantly associated with age, lower SES, tobacco use, and alcohol, and sugary drinks consumption. Clinical relevance Certain oral health behaviors have an impact on oral hygiene and on alkali production; it is important to address these factors with patients as a strategy for caries control. .

Caries-free subjects have high levels of urease and arginine deiminase activity

Objectives: This study investigated the relationship between urease and arginine deiminase system (ADS) activities and dental caries through a cross-sectional study. Material and Methods: Urease and ADS activities were measured in saliva and plaque samples from 10 caries-free subjects and 13 caries-active. Urease activity was obtained from the ammonia produced by incubation of plaque and saliva samples in urea. ADS activity was obtained from the ammonia generated by the arginine-HCl and Tris-maleate buffer. Specific activity was defined as micromoles of ammonia per minute per milligram of protein. Shapiro-Wilk statistical test was used to analyze the distribution of the data, and Mann-Whitney test was used to determine the significance of the data. Results: The specific urease activity in saliva and plaque was significantly higher in individuals with low DMFT scores. ADS activity in saliva (6.050 vs 1.350, p=0.0154) and plaque (8.830 vs 1.210, p=0.025) was also higher in individuals with low DMFT scores. Conclusions: Caries-free subjects had a higher ammonia generation activity by urease and arginine deiminase system for both saliva and plaque samples than low caries-active subjects. High levels of alkali production in oral environment were related to caries-free subjects. .

Correlation between Positive Rate and Number of Biopsy Samples on Urease Test in Childhood Helicobacter pylori Infection

To identify the correlation between the number of gastric biopsy samples and the positive rate, we compared the results of urease test using one and three biopsy samples from each 255 children who underwent gastroduodenoscopy at Gyeongsang National University Hospital. The children were divided into three age groups: 0-4, 5-9, and 10-15 yr. The gastric endoscopic biopsies were subjected to the urease test. That is, one and three gastric antral biopsy samples were collected from the same child. The results of urease test were classified into three grades: Grade 0 (no change), 1 (6-24 hr), 2 (1-6 hr), and 3 (<1 hr). The positive rate of urease test was increased by the age with no respect to the number of gastric biopsy samples (one biopsy P = 0.001, three biopsy P < 0.001). The positive rate of the urease test was higher on three biopsy samples as compared with one biopsy sample (P < 0.001). The difference between one and three biopsy samples was higher in the children aged 0-9 yr. Our results indicate that the urease test might be a more accurate diagnostic modality when it is performed on three or more biopsy samples in children.

Diagnosis of Helicobacter pylori infection by invasive and noninvasive tests

Although several invasive and noninvasive tests have been developed for the diagnosis of Helicobacter pylori infection, all of the tests have their limitations. We conducted a study to investigate and compare the suitability of rapid urease test (RUT), serology, histopathology and stool antigen tests with polymerase chain reaction (PCR) for detection of H. pylori, and correlate the diagnostic methods with PCR. Eighty nine patients (61 adults, 28 children) referred to the Firoozgar Hospital and Children Medical Center Hospital for diagnostic upper gastrointestinal endoscopy entered to the study and noninvasive tests such as immunoassay for serological antibodies against H. pylori and detection of its antigen in feces were measured. The biopsies were utilized for histological examination, RUT and PCR. The H. pylori statuses were evaluated by the positivity of ureC PCR in biopsy specimens and 53 subjects had H. pylori positive result. Histopathology showed high overall performance in adults and children with sensitivity and specificity 100% and 90%, respectively. Sensitivity, specificity, and accuracy for stool antigen test were 87.8%, 75% and 82%, respectively. Correlation of RUT, serology (IgG), histopathology and stool antigen tests with PCR were 0.82, 0.32, 0.91 and 0.63, respectively. In conclusion, the RUT and histopathology are as accurate as the PCR of biopsy and stool antigen test can consider as appropriate noninvasive test for detection of H. pylori infection.

Evaluation of diagnostic methods for the detection of Helicobacter pylori in gastric biopsy specimens of dyspeptic patients

Helicobacter pylori infects nearly 50% of the world's population. This microorganism is accepted as the most important agent of gastritis and as a risk factor for peptic ulcer disease and gastric adenocarcinoma. Currently many diagnostic methods exist for detecting H. pylori, however they all have limitations, thus it is recommend a combination of at least two methods. The aim of this study was to evaluate diagnostic methods, such as in-house urease test, culture and Polymerase Chain Reaction (PCR), for the detection of the H. pylori in gastric biopsy specimens of 144 dyspeptic patients, using as gold standard the association between histology and rapid urease test. According to the gold standard used in this study, 48 (33.3%) patients were infected with H. pylori, while 96 (66.7%) were classified as not infected. The in-house urease test and the PCR were the most sensitive methods (100%), followed by culture (85.4%). However, the in-house urease test and the culture were the most specific (100%), followed by PCR (75%). In conclusion, this study showed that, in comparison with the combination of histology and rapid urease test, the in-house urease test and the PCR presented 100% of sensitivity in the diagnosis of gastric infection by H. pylori, while the in-house urease test and the culture reached 100% of specificity. These finding suggest that the combination of two or more methods may improve the accuracy of the H. pylori detection.

Análise epidemiológica e emprego do teste rápido da urease em pacientes com úlcera péptica perfurada / Epidemiological analysis and use of rapid urease test in patients with perforated peptic ulcers

OBJETIVO: Analisar o perfil epidemiológico de pacientes com úlcera péptica gastroduodenal perfurada e verificar se a presença do H. pylori nas secreções peritoneais e intraluminais desses pacientes pode ser avaliada pelo teste rápido da urease. MÉTODOS: Realizou-se estudo prospectivo, transversal, descritivo, com dados de pacientes atendidos em um hospital de abrangência regional, em portadores de úlcera péptica perfurada. Coletou-se, no transoperatório, amostras de líquido peritoneal (na proximidade da perfuração) e da secreção intraluminal, sendo encaminhadas para cultura e teste rápido de urease. RESULTADOS: Quatorze pacientes foram analisados. A média etária foi 41,06 anos, todos homens, brancos (71,4%), tabagistas (57,2%), IMC < 30 (85,7%), com história prévia de dispepsia (78,6%). Sorologia para H. pylori foi positiva em 84,6% dos casos. O teste rápido da urease foi positivo em 78,6% das amostras do tubo digestivo e em 42,8% das amostras da cavidade peritoneal; 41,6% foram positivos em ambos os locais, 50% somente na cavidade digestiva e 8,4% exclusivamente na cavidade peritoneal. Dos 11 pacientes com sorologia positiva para H. pylori 100% apresentaram positividade em pelo menos um dos sítios pesquisados. CONCLUSÃO: Verificou-se que a incidência foi menor que a esperada. Há associação significativa entre a infecção pelo H. pylori e a ocorrência de perfuração. A presença deste patógeno pode ser avaliada tanto pela sorologia quanto pela realização do teste rápido da urease do fluido coletado na cavidade peritoneal e na luz gástrica/duodenal.

OBJECTIVE: To analyze the epidemiological profile of patients with gastroduodenal ulcer perforation and verify if the presence of H. pylori in the peritoneal and intraluminal secretions of these patients can be assessed by rapid urease test. METHODS: We conducted a prospective, descriptive, cross-sectional study with data from patients in a hospital at a regional level, in patients with peptic ulcer. During surgery, we collected peritoneal fluid samples (in the vicinity of the perforation) and intraluminal secretion, sending them for culture and rapid urease test. RESULTS: Fourteen patients were analyzed. The average age was 41.06 years, all men, Whites (71.4%), smokers (57.2%), BMI <30 (85.7%), with a history of dyspepsia (78.6%). Serology for H. pylori was positive in 84.6% of cases. The rapid urease test was positive in 78.6% of the samples of the digestive tract and 42.8% of samples from the peritoneal cavity; 41.6% were positive at both sites, 50% only in the digestive cavity and 8.4% only in the peritoneal cavity. Of the 11 patients with positive serology for H. pylori, 100% were positive in at least one of the sites surveyed. CONCLUSION: It was found that the incidence was lower than expected. There is significant association between infection with H. pylori and the occurrence of perforation. The presence of this pathogen can be assessed both by serology and by the realization of the rapid urease test from fluid collected in the peritoneal cavity and the gastric / duodenal lumen.

Evaluation of the effect of presence of blood in the stomach on endoscopic diagnostic tests for Helicobacter pylori infection.

Introduction: Presence of blood in the stomach has been thought to affect the performance of diagnostic tests used in detecting Helicobacter pylori (H. pylori) in the stomach. This study evaluated the effect of blood on the efficacy of rapid urease test (RUT) and microscopic appearance of the biopsy after staining with Giemsa stain. Materials and Methods: Patients with bleeding oesophageal varices who met the inclusion criteria were tested for H. pylori by RUT and microscopic examination of the biopsy. A repeat endoscopy, RUT and histology were done one month following initial presentation. The performance of the diagnostic tests was evaluated with and without the presence of intraluminal blood. A combined result of the two tests, RUT and histology, carried out in presence or absence of blood for the diagnosis of H. pylori, when considered together was considered as the gold standard. Results: Thirty six patients included in the study were in the ages ranging between 15-60 years (mean age = 44.14 years ±2.1). The combination of tests at both visits showed 20/36 (55.6%) patients were positive for H. pylori. The decrease in H. pylori positivity in the presence of blood was significant for RUT (8.3% vs. 38.9%; P=0.005) and combined test (19.4% vs. 47.2%; P=0.02) but the decrease in positivity for histology (11.1% vs 30.6%) was not significant (P=0.08). In the presence of blood, the sensitivity of RUT, histology and combined tests were 15%, 20% and 35%, respectively. In the absence of blood, the sensitivity of RUT, histology and combination of tests was 70%, 55% and 85%, respectively. Conclusion: Blood in the stomach significantly decreased the sensitivity of RUT, histology and the combination of both. Negative results of these tests in acute upper gastro intestinal (GI) bleeding should therefore be interpreted carefully.

Relación entre el grado de contacto perro-propietario y la carga de helicobacterias en mucosa gástrica canina / Relationship between grade of contact dog-owner and the helicobacterias on gastric mucosa

Las helicobacterias son bacterias Gram negativas de forma curva o helicoidal ampliamente distribuidas en estómago de humanos y de diversos animales, ya sea como microbiota normal o causante de patologías gastrointestinales. El objetivo del trabajo consistió en determinar la relación entre la presencia y carga de helicobacterias en caninos, con el grado de contacto con sus propietarios positivos a estas bacterias utilizando el test rápido de ureasa. Se utilizó una muestra de 31 perros sanos de la ciudad de Chillán, Chile, de los cuales por vía endoscópica se obtuvo biopsias de mucosa de fundus gástrico, los cuales se sometieron al test rápido de ureasa. Los propietarios de estos caninos eran todos positivos a helicobacterias, lo que fue determinado a través del mismo test. El noventa y siete porciento de las biopsias caninas fueron positivas a helicobacterias. El treinta y nueve por ciento de las biopsias que reaccionó positivamente al test de ureasa en menor tiempo, pertenecían a caninos cuyo grado de contacto con sus propietarios era muy cercano. Los resultados sugieren que las altas cargas de helicobacterias encontradas en los caninos podrían deberse al mayor grado de contacto que tienen estos animales con sus propietarios. Por ello, sería importante determinar, en futuros estudios, si estas mascotas pueden ser reservorio o fuente de transmisión para las personas o viceversa y las especies bacterianas involucradas.

Helicobacter, Gram negative bacterias are curved or helicoidal microorganisms, widely spread in the stomach of humans and several animals, found as normal microbiota or causing of gastrointestinal pathologies. The objective of the work consisted of determining the relation between the presence and loads of helicobacterias in canine, with the degree of contact with its positive owners proprietors to these bacteria using rapid urease test. A sample of 31 healthy dogs of the city of Chillán, Chile were used, from which gastric fungus biopsies were obtained by endoscopy. These biopsies were put under the Rapid Urease Test. The owner of these canines were all positive for helicobacteria, determined by means of the same test. Ninety sevent percent of the canine biopsies were positive for helicobacteria. Thirty nine percent of the biopsies with the fastest positive reaction to the urease test belonged to canines with a high contact grade to their owners. The results suggest that the high charges of helicobacteria found in canines could be because of the higher contact grade of these animals with their owner. It would be important then to determine in future studies, whether if these pets could be a reserve or a transmission source for people, or viceverse, and the bacterial species involved.

Helicobacter pylori coinfection is a confounder, modulating mucosal inflammation in oral submucous fibrosis.

The oral cavity has been considered a potential reservoir for Helicobacter pylori (H pylori) , from where the organism causes recurrent gastric infections. Aim: With this case-control study we tried to evaluate the role of H pylori in the etiology of mucosal inflammation, a condition that compounds the morbid state associated with oral submucous fibrosis (OSF). Materials and Methods : Subjects ( n = 150) were selected following institutional regulations on sample collection and grouped into test cases and positive and negative controls based on the presence of mucosal fibrosis and inflammation. The negative controls had none of the clinical signs. All patients underwent an oral examination as well as tests to assess oral hygiene/periodontal disease status; a rapid urease test (RUT) of plaque samples was also done to estimate the H pylori bacterial load. We used univariate and mutivariate logistic regression for statistical analysis of the data and calculated the odds ratios to assess the risk posed by the different variables. Results : The RUT results differed significantly between the groups, reflecting the variations in the bacterial loads in each category. The test was positive in 52% in the positive controls (where nonspecific inflammation of oral mucosa was seen unassociated with fibrosis), in 46% of the test cases, and in 18% of the negative controls (healthy volunteers) (χ2 = 13.887; P < 0.01). A positive correlation was seen between the oral hygiene/periodontal disease indices and RUT reactivity in all the three groups. Conclusions: The contribution of the H pylori in dental plaque to mucosal inflammation and periodontal disease was significant. Logistic regression analysis showed gastrointestinal disease and poor oral hygiene as being the greatest risk factors for bacterial colonization, irrespective of the subject groups. A positive correlation exists between RUT reactivity and the frequency of mucosal inflammation.

Estudio de test de ureasa en exámenes endoscópicos con patologías benignas: ¿algún cambio en diez años? / Positivity of urease tests: results of its application in an open-access unity after a decade is there any change?

Epidemiological studies have shown changes in upper digestive diagnosis in recent times. It has been observed especially in developed countries, consisting in a diminution of duodenal peptic ulcers and non cardial gastric cancer and an increase of symptoms and lesions attributable to gastroesophageal reflux. Both circumstances have been considered as a consequence of a reduction in the prevalence, of infection with Helicobacter pylori and its more aggressive strains. There is little information of Possible changes in our country, so we have studied our experience in years 1996 and 2006 observing the results of Helicohacter pylori presence through urease tests and biopsies in a 10 year period. Patients were assessed with endoscopy indicated for upper digestive symptoms in an open access University Endoscopy Center. The accuracy of the test compared with biopsies was similar in both years. We observed after a decade: increase in the number of examinations and urease tests similar percentages of normal endoscopies and those with esophagitis, gastritis, or ulcers. In patients studied for suspected gastroesophageal reflux, there were similar percentages of those with and without esophageal erosions. The Urease Test was positive in similar high percentage in duodenal ulcers, but showed decreased values in patients studied for reflux, both erosive and non erosive esophagitis and also in erosive gastritis. In conclusion, Helicobacter pylori infection is still important in duodenal ulcer, with reductions in other diagnosis, possibly as a consequence of differences in patients social status or the very common medication aiming at the eradication of the infection or control of gastroesophageal symptoms.

Estudios epidemiológicos han mostrado cambios en la incidencia de patologías digestivas consistentes en disminución de úlceras duodenales y cáncer gástrico y aumento de cuadros atribuidos a reflujo gastroesofágico. Ambas tendencias se han asociado a disminución de la tan difundida infección por Helicobacter pylori y sus cepas genéticamente más agresivas. El presente estudio tuvo come objeto revisar retrospectivamente los resultados de endoscopias en 1996 y 2006 para observar eventuales cambios en la patología de esófago y gastroduodenal. Los resultados en la última década indican: aumento del número de exámenes y de tests de ureasa; proporción similar, de: endoscopias normales, esofagitis erosiva, síntomas de reflujo no erosivo, gastritis erosiva, úlcera gástrica, úlcera duodenal; porcentaje similar de esofagitis erosiva y reflujo no erosivo en pacientes estudiados por síntomas sugerentes de reflujo gastroesofágico y disminución de la positividad del TU, significativamente en EE y GE. Pensamos que el Hp continúa siendo factor patogénico en UD y que la disminución de positividad en pacientes con RGE puede atribuirse a cambios en la composición de la población examinada y al uso de medicación que puede modificar su presencia en la mucosa de estómago, siendo similar la reducción en reflujo con y sin esofagitis erosiva.

Determinación de la presencia de Helicobacter spp. en perros, mediante biopsia gástrica obtenida por endoscopía / Determination of Helicobacter spp. by gastric biopsy obtained by endoscopy in dogs

Con el objeto de determinar la frecuencia de presentación de Helicobacter spp. se realizó un estudio en caninos de Valdivia, Chile, a través de biopsia gástrica de las zonas fúndica y pilórica obtenida por endoscopía y analizadas mediante las pruebas de ureasa e histología. Los resultados indican que la bacteria Helicobacter spp. fue detectada en todos los perros. La prueba de ureasa dio resultados positivos a Helicobacter en el 86,2 por ciento de las muestras de la zona fúndica y en el 75,9 por ciento del antro pilórico. El examen histológico reveló la bacteria en todas las muestras fúndicas y en el 92 por ciento de las muestras del antro pilórico. En la zona fúndica las frecuencias obtenidas entre la prueba de ureasa e histología resultaron estadísticamente significativas, a diferencia de lo que se obtuvo en la zona del antro pilórico. La bacteria fue encontrada en perros de todas las edades de ambos sexos. Las muestras que resultaron positivas a la prueba de ureasa, reaccionaron principalmente entre las 3 y 24 horas de incubación. En el examen histológico se determinó el grado de infección por el Helicobacter spp., siendo las muestras clasificadas mayormente en los grados moderado a marcado, ubicándose sobre la superfiscie de la mucosa, en las fosas gástricas, glándulas gástricas y en las células parietales.

A study was carried out in order to determinate Helicobacter spp. in dogs of Valdivia city, Chile. Gastric mucosal biopsy from fundus and pyloric antrum were obtained by endoscopy and analized by urease test and histology.Stomach endoscopic appearance, frecuency presentation of Helicobacter spp. according to sex and age, time reaction to urease test, degree of infection and distribution Helicobacter spp. were analized. Results indicated that Helicobacter spp. was detected in all dogs. The urease test was positive in 86.2% of the fundus samples and in 75.9% of the pyloric antrum samples. Histological examination revealed the bacterium in all of the fundus samples and in 92% of the antrum samples. In fundus samples the frecuency obtained by urease test and histology resulted statistically significant, different to the results obtained in the antrum region. Helicobacter spp. was found in young and old animals of both sexes. Samples that gave positive results in the urease test reacted mainly between 3 to 24 hours post incubated. Histological examination to determinate degree of infection to Helicobacter spp., were classified moderate to marked degree and detected on the mucosal surface, gastric pits, gastric glands and parietal cells.

Diagnóstico de la infección poe Helicobacter pylori en niños mediante la detección de antígenos en deposiciones / Diagnosis of Helicobacter pylori infection in children based on stool antigen test

Background: During infancy, preventive, diagnostic and therapeutic efforts for Helicobacter pylori infection should be made. Aim: To evaluate non-invasive diagnostic methods such as stool antigen test (HpSA) and serum anti-H pylori antibody detection (IgG e IgA), compared to endoscopy-based invasive methods (histology and urease test) for the diagnosis of Helicobacter pylori infection. Patients and Methods: Thirty nine children (aged 3 to 14 years, 20 males) referred for upper gastrointestinal endoscopy, were studied. The gold standard to diagnose Helicobacter pylori infection was defined as a positive invasive diagnostic test (histology and/or urease test). Sensitivity (S), specificity (E) and positive (PPV) and negative (NPV) predictive values were obtained for HpSA and serum antibodies. Results: Ten children (26 percent) were infected with H pylori. S, E, PPV and NPV for HpSA were 90, 100, 100 and 97 percent, respectively. The figures for serum IgG were 81, 97, 89 and 93 percent, respectively and for IgA, 90, 76, 36 and 96 percent, respectively. Conclusions: HpSA was sensitive and specific as a clinical and epidemiological tool to evaluate H pylori infection in children. Serology was not as accurate, but IgG had a better performance than IgA.

Prevalence of Helicobacter pylori infection in advanced gastric carcinoma

BACKGROUD: There is substantial evidence that infection with Helicobacter pylori plays a role in the development of gastric cancer and that it is rarely found in gastric biopsy of atrophic gastritis and gastric cancer. On advanced gastric tumors, the bacteria can be lost from the stomach. AIMS: To analyze the hypothesis that the prevalence of H.pylori in operated advanced gastric carcinomas and adjacent non-tumor tissues is high, comparing intestinal and diffuse tumors according to Lauren's classification METHODS: A prospective controlled study enrolled 56 patients from "Hospital Universitário", Federal University of Rio Grande do Norte, Natal, RN, Brazil, with advanced gastric cancer, treated from February 2000 to March 2003. Immediately after partial gastrectomy, the resected stomach was opened and several mucosal biopsy samples were taken from the gastric tumor and from the adjacent mucosa within 4 cm distance from the tumor margin. Tissue sections were stained with hematoxylin and eosin. Lauren's classification for gastric cancer was used, to analyse the prevalence of H. pylori in intestinal or diffuse carcinomas assessed by the urease rapid test, IgG by ELISA and Giemsa staining. H. pylori infected patients were treated with omeprazole, clarithromycin and amoxicillin for 7 days. Follow-up endoscopy and serology were performed 6 months after treatment to determine successful eradication of H. pylori in non-tumor tissue. Thereafter, follow-up endoscopies were scheduled annually. Chi-square and MacNemar tests with 0.05 significance were used. RESULTS: Thirty-four tumors (60.7 percent) were intestinal-type and 22 (39.3 percent) diffuse type carcinomas. In adjacent non-tumor gastric mucosa, chronic gastritis were found in 53 cases (94.6 percent) and atrophic mucosa in 36 patients (64.3 percent). All the patients with atrophic mucosa were H. pylori positive. When examined by Giemsa and urease test, H. pylori positive rate in tumor...

RACIONAL: Existe evidência de que a infecção pelo Helicobacter pylori desempenha papel importante na causa do câncer gástrico e que é raramente encontrada em biopsias de gastrite atrófica e em tecido tumoral de câncer do estômago. Com a evolução para câncer gástrico avançado, a bactéria tende a desaparecer do tecido tumoral OBJETIVOS: Analisar a prevalência do H. pylori em peças operatórias de carcinomas gástricos avançados e no tecido adjacente aos tumores, comparando os tumores tipo intestinal e difuso de acordo com a classificação de Lauren MÉTODOS: Estudo prospectivo controlado incluiu 56 pacientes operados no Hospital Universitário da Universidade Federal do Rio Grande do Norte, Natal, RN, com câncer gástrico avançado, entre fevereiro de 2000 e março de 2003. Imediatamente após a gastrectomia, a peça operatória foi aberta e foram feitas várias biopsias do tecido neoplásico e da mucosa adjacente a 4 cm da margem tumoral. Os tecidos formam processados e corados pela hematoxilina-eosina. Foi usada a classificação de Lauren para carcinoma gástrico. A infecção pelo H. pylori foi diagnosticada pelo teste da urease, dosagem de IgG por ELISA e histopatologia com coloração Giemsa. Os pacientes infectados pelo H. pylori foram tratados com omeprazol, claritromicina e amoxicilina por 7 dias. Após 6 meses, 1 ano e 2 anos, foi feito seguimento utilizando endoscopia, dosagem de IgG e teste da urease para avaliar o sucesso da erradicação do H. pylori e recidiva do tumor RESULTADOS: O carcinoma tipo intestinal ocorreu em 34 (60,7 por cento) pacientes e 22 (39,3 por cento) foram acometidos de carcinoma difuso. No tecido adjacente não-tumoral a gastrite crônica foi observada em 53 casos (94,6 por cento) e mucosa atrófica em 36 pacientes (64,3 por cento), todos H. pylori positivos. Exames pelo Giemsa e teste da urease revelaram maior prevalência de H. pylori positivo no tecido tumoral do carcinoma tipo intestinal do que no tipo difuso. Quando foi comparada...