ABSTRACT
The sera of 142 Helicobacter pylori-positive and 32 H. pylori-negative patients were assessed by a desktop test (QuickVue), an enzyme-linked immunosorbent assay (ELISA) (HM-CAP), and a solid-phase, two-step chemiluminescent enzyme immunoassay (Immulite). These tests yielded sensitivities of 97, 97, and 91% and specificities of 97, 94, and 100%, respectively. In conclusion, the desktop test and the ELISA are more sensitive than the chemiluminescent enzyme immunoassay (P < 0.05). The chemiluminescent enzyme immunoassay has the advantage that it is fully automated.
Subject(s)
Helicobacter Infections/diagnosis , Helicobacter pylori/immunology , Immunoenzyme Techniques , Serologic Tests , Adult , Antibodies, Bacterial/blood , Endoscopy , Enzyme-Linked Immunosorbent Assay , Evaluation Studies as Topic , Gastritis/microbiology , Helicobacter Infections/immunology , Helicobacter Infections/microbiology , Humans , Luminescent Measurements , Peptic Ulcer/microbiology , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
BACKGROUND: Metronidazole-containing eradication therapies are less effective for metronidazole resistant Helicobacter pylori. Although early data suggested improvement of the efficacy of bismuth triple therapy after the addition of acid suppressives, these findings were based on studies with small numbers of patients, incomplete post-eradication follow up, or omission of pretreatment susceptibility testing. AIMS: To study the efficacy of quadruple therapy in the Amsterdam area, where the efficacy of bismuth triple therapy has been proved to be affected by metronidazole resistance. PATIENTS AND METHODS: Eighty two consecutive dyspeptic H pylori positive patients with either metronidazole susceptible (group I) or metronidazole resistant H pylori strains (group II) received quadruple therapy for one week: omeprazole 20 mg twice daily; colloidal bismuth subcitrate 120 mg four times a day; tetracycline 500 mg four times a day; metronidazole 500 mg three times a day. Susceptibility to metronidazole was determined by the E-test. RESULTS: Intention to treat analysis showed that H pylori infection had been cured in 42/43 patients (98%) in group I and 32/39 patients (82%) in group II (p = 0.02). CONCLUSION: The efficacy of quadruple therapy is significantly impaired in patients infected with metronidazole resistant H pylori. Therefore a non-metronidazole-containing regimen should preferably be used in areas known to have a high prevalence of pretreatment metronidazole resistance.
Subject(s)
Antitrichomonal Agents/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori , Metronidazole/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Drug Resistance, Microbial , Drug Therapy, Combination , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Omeprazole/therapeutic use , Organometallic Compounds/therapeutic use , Patient Selection , Tetracycline/therapeutic use , Treatment OutcomeABSTRACT
The interrelationship between cytotoxin-associated gene A (CagA), vacuolating cytotoxin (VacA), and Helicobacter pylori-related diseases was investigated in 155 H. pylori-infected patients. Four (7%) of 60 subjects had mixed cagA+ and cagA- H. pylori infections. The H. pylori isolates from 98.3% of 121 patients with anti-CagA antibodies were cagA+. The occurrence of cagA+ H. pylori among 76 patients with peptic ulcer disease (PUD) was higher (93.4%) than among 79 patients with functional dyspepsia (FD; 64.6%) (odds ratio [OR] = 7.80; P < .001). VacA+ isolates were isolated from 56.6% of the PUD patients and 35.4% of the FD patients (OR = 2.37; P = .0132). For type I (cagA+VacA+) isolates, these numbers were 56.6% and 31.6%, respectively (P = .003). Only 4% of the 71 VacA+ isolates were cagA-. In addition, 37% of the patients with PUD were infected with cagA+VacA- H. pylori. Chi 2 results did not improve when VacA was entered into the model in the presence of cagA, indicating that only cagA is associated with PUD.
