Usefulness of serological IgG antibody determinations for confirming eradication of Helicobacter pylori infection.

OBJECTIVE: Prior studies have suggested that IgG antibody titers may be useful to confirm successful treatment of Helicobacter pylori (H. pylori) infection. However, the diagnostic value of decreasing IgG titers is limited by the necessity to perform pre and posttreatment tests in parallel which requires stored sera. Our objective was to assess the accuracy of IgG antibody titers using the HM-CAP IgG EIA kit (Enteric Products) in monitoring treatment of H. pylori infection and to compare the relative accuracy of parallel versus serial determinations. METHODS: The 14C urea breath test (UBT) was used to confirm H. pylori infection in 83 dyspeptic patients and eradication of the organism at 4 wk and 6 months posttreatment. IgG titers pretherapy and 6 months posttherapy were determined either serially (separate EIA plates) or in parallel (same EIA plate), and the relative percent decline in antibody titer was calculated. RESULTS: When a decline of > or = 25% at 6 months was used as the cut-off for H. pylori eradication, mean sensitivities of serial and parallel determinations were 87.5% and 86.8%, respectively, and mean specificities of both were 100%. In 68 of 75 patients in whom the organism was eradicated, the mean decrease in IgG titer at 6 months was 41.1% for serial determinations and 41.5% for parallel determinations. CONCLUSIONS: Serial or parallel IgG titers offer equivalent diagnostic accuracy for confirming H. pylori eradication after therapy. A > or = 25% decline in titer 6 months after therapy is a sensitive and specific marker for eradication of the infection. Serial evaluation of IgG titers does not require serum storage, and is a cost-effective and accurate alternative to the UBT or endoscopy-based methods.

Diagnosis and treatment of Helicobacter pylori in Guyana - abstract

This study was designed to assess usefulness of an HP, igG serum blot immunoassay, "Flex-sure test" (F/S) in accurately guiding treatment of HP infection, to compare metronidazole 500mg bd, omeprazole 20 mg bd and clarithromycin 500 mg bd orally (MOC); and amoxicillin 500 mg bd, omeprazole 20 mg bd and clarithromycin 500 mg bd orally (AOC) for 10 days, ineradicating HP 115 of 322 patients with moderate to severe dyspeptic symptoms who were screen with the F/S test were positive and were randomly assigned to 2 treatment regimes. C14 breadth test (B/T) was performed to confirm infection at the start of the treatment, 4 weeks and 6 months after the treatment. 12/115 patient (10.4 percent) were withdrawn from the study after three confirmatory B/T were negative. 6/115 patients (5.2 percent) did not return for treatment. Ninety-seven (97) F/S and B/T positive patients were treated and followed up for 6 months. The most significant symptomatic relief occurred at the first month post-treatment. Bitterness, headache, nausea and diarrhea were the major symptoms experienced. The recurrent rate of HP at 6 months was 2/97 (2 percent). We conclude that F/S assay is a good and fairly accurate screen to commence primary therapy and that MOC and AOC are equally effective in eradicating HP after 10 days of oral theraphy with low recurrence at 6 months. (AU)

Variation between centers in technique and guidelines for liver biopsy.

Hospitals have few published guidelines to follow when performing a liver biopsy. In 1992, we began revising our protocol in an effort to institute new guidelines for our teaching hospitals. To assess the current practice of liver biopsy, we sent 500 multilingual questionnaires to international academic centers, and 85 U.S. centers were surveyed by telephone. The survey assessed: 1) patient preparation, 2) technical aspects of the biopsy, and 3) post-procedural care. One hundred and eighty international centers and 85 U.S. centers responded (total = 265). We found a wide variation in the practice of this surgical procedure at both national and international centers. Many Asian centers (73%) performed a bleeding time prior to liver biopsy. This practice was seen in only 36% of the U.S. centers. Most centers preferred platelet counts of 50,000/mm3 and above. The aspiration needle was more widely used in the U.S. (74%) and in many international centers, but Asian centers (61%) preferred a cutting needle. Thirty percent of Japanese centers performed more than 50% of their liver biopsies laparoscopically. Few laparoscopies were done at other centers. While about a quarter of the reported U.S., European, Asian, and South American centers observed patients for 4-6 hours after a biopsy, the majority of centers observed patients 10 hours or more. In addition to the wide variation seen, this survey provided us with an academic view of the contemporary practice of liver biopsy and an insight into how to redefine our present guidelines.