Urea breath test for Helicobacter pylori infection in adult dyspeptic patients: A meta-analysis of diagnostic test accuracy.

BACKGROUND: Helicobacter pylori (H. pylori) infection has been well-established as a significant risk factor for several gastrointestinal disorders. The urea breath test (UBT) has emerged as a leading non-invasive method for detecting H. pylori. Despite numerous studies confirming its substantial accuracy, the reliability of UBT results is often compromised by inherent limitations. These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H. pylori infection. AIM: To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H. pylori infection in adult patients with dyspepsia. METHODS: We conducted an independent search of the PubMed/MEDLINE, EMBASE, and Cochrane Central databases until April 2022. Our search included diagnostic accuracy studies that evaluated at least one of the index tests (13C-UBT or 14C-UBT) against a reference standard. We used the QUADAS-2 tool to assess the methodological quality of the studies. We utilized the bivariate random-effects model to calculate sensitivity, specificity, positive and negative test likelihood ratios (LR+ and LR-), as well as the diagnostic odds ratio (DOR), and their 95% confidence intervals. We conducted subgroup analyses based on urea dosing, time after urea administration, and assessment technique. To investigate a possible threshold effect, we conducted Spearman correlation analysis, and we generated summary receiver operating characteristic (SROC) curves to assess heterogeneity. Finally, we visually inspected a funnel plot and used Egger's test to evaluate publication bias. RESULTS: The titles and abstracts of 4621 studies were screened; 79 articles were retrieved and selected for full-text reading. Finally, 60 studies were included in the diagnostic test accuracy meta-analysis. Our analysis demonstrates superior diagnostic accuracy of 13C-UBT over 14C-UBT, indicated by higher sensitivity (96.60% vs 96.15%), specificity (96.93% vs 89.84%), likelihood ratios (LR+ 22.00 vs 10.10; LR- 0.05 vs 0.06), and area under the curve (AUC; 0.979 vs 0.968). Notably, 13C-UBT's DOR (586.47) significantly outperforms 14C-UBT (DOR 226.50), making it the preferred diagnostic tool for dyspeptic individuals with H. pylori infection. Correlation analysis revealed no threshold effect (13C-UBT: r = 0.48; 14C-UBT: r = -0.01), and SROC curves showed consistent accuracy. Both 13C-UBT and 14C-UBT showed high AUC values (13C-UBT 0.979; 14C-UBT 0.968) near 1.00, reinforcing their excellent accuracy and endorsing both as reliable diagnostic tools in clinical practice. CONCLUSION: In summary, our study has demonstrated that 13C-UBT has been found to outperform the 14C-UBT, making it the preferred diagnostic approach. Additionally, our results emphasize the significance of carefully considering urea dosage, assessment timing, and measurement techniques for both tests to enhance diagnostic precision. Nevertheless, it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.

Prevalence of Helicobacter pylori infection among asymptomatic children in southeastern Brazil: a cross-sectional study

ABSTRACT BACKGROUND: The prevalence of Helico bacter pylori (H. pylori) infection is decreasing worldwide, but is still high in developing countries. We previously observed an H. pylori infection rate of 52% among children and adolescents with chronic non-ulcer dyspepsia. OBJECTIVE: To investigate the prevalence of H. pylori infection among asymptomatic children living in a single region and to evaluate the risk factors for this infection. DESIGN AND SETTING: Cross-sectional study in which 161 children aged 5-13 years (mean age 7.8 years), at a public school in Botucatu, state of São Paulo, southeastern Brazil, were assessed. METHOD: The children's H. pylori infection status was determined through the urea breath test and the risk factors for acquisition of the infection were determined based on a sociodemographic questionnaire. RESULTS: The overall prevalence of H. pylori infection was 20.5%: 18.7% among females and 22.2% among males. The results from the sociodemographic survey did not differ between children with and without H. pylori infection. 30.9% of the children had previous records of upper gastrointestinal symptoms, which consisted of H. pylori infection in only 26.5% of these cases. Family histories of gastritis and peptic ulcer disease were found in relation to 50% and 32.3% of the children with H. pylori infection respectively. CONCLUSION: The prevalence of H. pylori infection among asymptomatic children in southeastern Brazil is lower than that recorded among symptomatic children in the same region and similar to the prevalence of H. pylori infection observed in developed countries.

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.

Association of cagA+ Helicobacter pylori strains with high urease activity and dyspepsia in Mexican adults. / Asociación de cepas de Helicobater pylori cagA+ con alta actividad de ureasa y dispepsia en adultos mexicanos.

INTRODUCTION AND AIMS: Helicobacter pylori (H. pylori) is associated with a higher risk of peptic ulcer and gastric cancer. The sole presence of the bacterium is not a determinant of clinical outcome, but rather the interaction of strain type and host factors determines the risk of disease. Our aim was to study the association between bacterial load, strain type, and gastric symptoms in H. pylori-positive subjects. MATERIALS AND METHODS: In a community survey, a diagnostic 13C-urea breath test for H. pylori was performed on 302 volunteers that were not taking antibiotics, antacids, or proton pump inhibitors one month prior to the test. The breath test produced 25 H. pylori-positive subjects, between 25-74 years of age, who then took a gastric symptoms survey and were tested for the presence of the cagA genotype in gastric juice, using the Entero-test®. Bacterial load was determined as a measure of urease activity, utilizing the delta over baseline value, obtained in the 13C-urea breath test. RESULTS: A total of 48% of the H. pylori-positive subjects were cagA+. A positive association was found between cagA status and high gastric urease activity (P<.0001) and the latter was significantly associated with the presence of symptoms (P<.0001). CONCLUSION: Gastric urease activity was strongly associated with dyspeptic symptoms and cagA+ H. pylori. Elevated 13C-delta over baseline values could be used as indicators of a higher risk for gastric disease.

Is breath testing without 13C-labelled external urea able to detect Helicobacter pylori infection?

Helicobacter pylori (H. pylori) infection is the main cause of gastric inflammation and peptic ulcer disease. Diagnosis and treatment are important to prevent these outcomes. The diagnosis of H. pylori infection can be performed by non-invasive methods, such as 13C-urea breath test (13C-UBT). As endogenous urea is normally released to body cavities, we sought to investigate the usefulness of UBT without 13C-labelled external urea to detect H. pylori infection. The analysis was performed in a series of adult patients just before upper gastrointestinal endoscopy and biopsy to investigate dyspeptic symptoms. Breath samples were analyzed using isotope ratio mass spectrometry (IRMS). The natural variation of 13C and 18O isotopic abundance in the breath samples was also investigated. The results of the isotopic analysis were compared with the findings of the histopathological evaluation of gastric biopsies, which is the gold standard to detect H. pylori infection. No differences between patients with or without H. pylori infection could be detected by the isotope analysis of breath tests without 13C-urea. Therefore, our results showed that UBT without 13C-urea, analyzed by IRMS, was not useful to detect H. pylori infection in the study population.

Performance of the 13C-urea breath test for the diagnosis of H. pylori infection using a substrate synthesized in Brazil: A preliminary study

OBJECTIVE: The 13C-urea breath test is the main non-invasive test for the diagnosis of Helicobacter pylori infection. The availability of this test throughout the country is limited, mainly due to the difficulty in obtaining the labeled isotope from abroad. Recently, researchers from the Nuclear Energy Center in Agriculture at the University of São Paulo (CENA/USP) succeeded in synthesizing 13C-enriched urea for Helicobacter pylori diagnosis. The aim of the study was to compare the performance of the 13C-urea breath test using 13C-urea acquired abroad with that of a test using 13C-urea synthesized in Brazil. METHOD: Sixty-four dyspeptic patients participated in the study (24 men and 40 women). Initially, the patients performed the 13C-urea breath test using the imported substrate (Euriso-Top, France). Seven to fourteen days later, all the patients repeated the test using the Brazilian substrate. The samples from both examinations were processed in an infrared isotope analyzer (IRIS, Wagner Analisen Technik, Germany), and all delta over baseline (DOB) [%] values above four were considered positive results. RESULTS: Twenty-seven patients (42%) exhibited negative results for Helicobacter pylori infection, and thirty-seven patients (58%) exhibited positive results when tested using the foreign substrate (gold standard). There was a 100% concordance regarding the presence or absence of infection when the gold standard results were compared with those obtained using the Brazilian substrate. CONCLUSIONS: Similar performance in the diagnosis of Helicobacter pylori infection was demonstrated when using the 13C-urea breath test with the Brazilian 13C-urea substrate and the test with the substrate produced abroad. This validation represents an important step toward increasing the availability of the 13C-urea breath test throughout the country, which will have a positive influence on the management of Helicobacter pylori infection.

Present and past Helicobacter pylori infection in Mexican school children.

BACKGROUND: In developing countries, more than 50% of children have serological evidence of Helicobacter pylori infection. However, serological tests for H. pylori did not differentiate between active and past infection. The objectives of this study were to estimate the frequency of active and past H. pylori infection utilizing functional urea breath test (UBT) and serological tests and evaluate factors associated with the infection. METHODS: A total of 675 school children, 6-13 years of age, participated. UBT was performed to detect active H. pylori infection. Blood samples were obtained to determine iron status and Immunoglobulin G (IgG) responses to the H. pylori whole-cell and to Cag A antigens by antigen-specific enzyme-linked immunosorbent assays. Weight, height, and sociodemographic characteristics were recorded. RESULTS: A total of 37.9% (95% Confidence Intervals (CI): 34.2-41.6) of school children had active or past H. pylori infection; of them, 73.8% (CI95% 68.4-79.2) were carrying CagA-positive strain, 26.5% (CI95% 23.2-29.8) had active infection, and 11.4% (95%CI: 9.0-13.8) had evidence of past H. pylori infection. School children with iron deficiency and low height for age had higher risk of H. pylori infection: [OR to active or past infection was 2.30 (CI 95% 1.01-5.23) and to active infection it was 2.64 (CI 95% 1.09-6.44)] compared to school children with normal iron status and height for age or with normal iron status but low height for age or with iron deficiency and normal height for age. CONCLUSIONS: The estimated prevalence of infection depends of the test utilized. Frequency of H. pylori infection and carrying CagA-positive strains was high in this population. Malnutrition was associated with active H. pylori infection.

La anemia como manifestación de la infección por Helicobacter pylori / Anemia as a manifestation of helicobacter pylori infection

Helicobacter pylori es el agente causal de infección más frecuente de la especie humana, con una marcada desventaja entre los países desarrollados y los países en vía de desarrollo, donde es mucho más frecuente. Si bien la infección por Helicobacter pylori cursa asintomática en la mayoría de los individuos infectados también es claro que está íntimamente relacionada con enfermedades malignas del estómago como el cáncer gástrico y el linfoma MALT; y enfermedades benignas como la gastritis crónica y la úlcera péptica duodenal y gástrica. A partir del momento en que se conoció que la mucosa gástrica podía ser colonizada por una bacteria, en la literatura médica mundial indexada (PubMed) se han informado alrededor de una centena de manifestaciones extragástricas que involucran a especialidadesmédicas tan disímiles como la cardiología, la dermatología, la endocrinología, la ginecoobstetricia, la hematología, la neumología, la neurología, la odontología, la oftalmología, la otorrinolaringología, la pediatría, la siquiatría y vascular periférico, algunas de ellas con mayor o menor acervo probatorio de la relación entre la infección por Helicobacter pylori y el desarrollo de la enfermedad. Esta revisión de la literatura médica mundial se centra en el análisis de la relación de la infección por Helicobacter pylori con las deficiencias de hierro y de vitamina B12, con o sin anemia. Se presentan para ambas formas de anemia, una visión general del problema, las evidencias de la asociación de cada una de ellas con la infección por Helicobacter pylori, la fisiopatología y el manejo en la era poshelicobacter.

Helicobacter pylori is the most common causative agent of human infection, with a marked disadvantage between developed and developing countries. Although Helicobacter pylori infection is asymptomatic in majority of individuals infected, it is also clear their close relation with malignant diseases of the stomach as gastric cancer and gastric MALT lymphoma; and benign diseases such as chronic gastritis and duodenal and gastric peptic ulcer. Since the moment that was known that the gastric mucosa can be colonized by bacteria, it has been informed about a hundred extragastric events in the indexed world medical literature (PubMed), that involves medical specialties as diverse as cardiology,dermatology, endocrinology, obstetrics and gynecology, hematology, pulmonology, neurology, dentistry, ophthalmology, otolaryngology, pediatrics, psychiatry, and peripheral vascular. Some of these with varying proofs of relation between Helicobacter pylori infection and disease development. This review was focuses on the analysis of the relationship between Helicobacter pylori infection with the iron and vitamin B12 deficiencies, with or without anemia. The information is presented for both forms of anemia, the problem overview, evidence of the association with Helicobacter pylori infection, the pathophysiology and management in poshelicobacter era.

La trombocitopenia inmune como manifestación de la infección por Helicobacter pylori / Immune thrombocytopenia as a manifestation of Helicobacter pylori infection

Resumen: Helicobacter pylori es el agente causal de la infección más frecuente de la especie humana, con una marcada desventaja entre los países desarrollados y los países en vía de desarrollo. Si bien, la infección por Helicobacter pylori cursa asintomática en la mayoría de los individuos infectados, también es claro que está íntimamente relacionada con enfermedades malignas del estómago como el cáncer gástrico y el linfoma MALT gástrico; y enfermedades benignas como la gastritis crónica y la úlcera péptica duodenal y gástrica. A partir del momento en que se conoció que la mucosa gástrica podía ser colonizada por una bacteria, en la literatura médica mundial indexada (PubMed) se han informado alrededor de una centena de manifestaciones extragástricas que involucran a especialidades médicas tan disímiles como la cardiología, la dermatología, la endocrinología, la ginecobstetricia, la hematología, la neumología, la neurología, la odontología, la oftalmología, la otorrinolaringología, la pediatría, la siquiatría y vascular periférico, algunas de ellas con mayor o menor acervo probatorio entre la infección por Helicobacter pylori y el desarrollo de la enfermedad. Esta revisión de la literatura médica mundial se centra en el análisis de la relación de la infección por Helicobacter pylori con la trombocitopenia inmune (ITP), antes conocida como púrpura trombocitopénica idiopática. Se presenta una visión global de la ITP, las evidencias de la asociación con la infección por Helicobacter pylori, la fisiopatología y el manejo de ésta en la era poshelicobacter.

Abstract: Helicobacter pylori is the most common causative agent of human infection, with a marked disadvantage between developed and developing countries. Although Helicobacter pylori infection is asymptomatic in majority of individuals infected, it is also clear their close relation with malignant diseases of the stomach as gastric cancer and gastric MALT lymphoma and benign diseases such as chronic gastritis and duodenal and gastric peptic ulcer. Since the moment it became know that bacteria could colonize the gastric mucosa, hundred extragastric events have been reported in the indexed world medical literature (PubMed), that involves medical specialties as diverse as cardiology, dermatology, endocrinology, obstetrics and gynecology, hematology, pulmonology, neurology, dentistry, ophthalmology, otolaryngology, pediatrics, psychiatry and peripheral vascular. Some of these with varying proofs of relation between Helicobacter pylori infection and disease development. This review focuses in the analysis of the relationship between Helicobacter pylori infection and immune thrombocytopenia (ITP), known as idiopathic thrombocytopenic purpura. The information for ITP includes the problem overview, evidence of the association with Helicobacter pylori infection, the pathophysiology and managementin poshelicobacter era.

Prevalence of Helicobacter pylori Infection in Children in The Bahamas / Prevalencia de la Infección por Helicobacter pylori en los Niños en La Bahamas

OBJECTIVE: Helicobacter pylori (H pylori) is a common bacterial infection that is associated with significant morbidity and mortality worldwide. This bacterium causes a chronic infection that is causally related to illnesses ranging from gastritis, peptic ulcer disease to gastric cancer. It is generally considered that it is acquired in childhood but the prevalence varies considerably between countries and communities. There are few data on the prevalence of H pylori in the Caribbean and none on the prevalence of H pylori in children in the Bahamas. The aim of this pilot study was to determine the prevalence of H pylori infection in a cohort of school children in the Bahamas. METHODS: One hundred and sixty-one children attending a public primary school in the Bahamas were invited to participate in this study. Consent was obtained for 107 children and each participant completed a brief questionnaire. Valid data were available for 96 of these children. Active H pylori infection was determined using the 13C urea breath test (UBT). RESULTS: Fifty-two children tested positive for H pylori, yielding a prevalence of 54.2%. The median age in the study was nine years with 46.9% male and 53.1% female. No significant relationship was found between gender, breastfeeding, pets and H pylori status. CONCLUSION: The prevalence reported in this study is the highest reported in asymptomatic children in the Caribbean. Further studies are required to determine risk factors for acquisition of H pylori infection in this population.

OBJETIVO: Helicobacter pylori (H pylori) es la causa de una infección bacteriana común a nivel mundial, asociada con una morbosidad y mortalidad significativas. Esta bacteria causa una infección crónica que se haya causalmente relacionada con un número de enfermedades que van desde la gastritis y la úlcera péptica hasta el cáncer gástrico. Generalmente se considera que es adquirida en la niñez, pero la prevalencia varía considerablemente entre los países y comunidades. Hay pocos datos con relación a la prevalencia de H pylori en el Caribe, y no existe ningún dato sobre la prevalencia de H pylori en los niños de Bahamas. El objetivo de este estudio piloto fue determinar la prevalencia de la infección por H. pylori en una cohorte de niños escolares en la Bahamas. MÉTODOS: Ciento sesenta y un niños que asistían a una escuela primaria pública en Bahamas, fueron invitados a participar en este estudio. Se obtuvo consentimiento para 107 niños, y cada participante respondió a una breve encuesta. Había datos válidos disponibles para 96 de estos niños. La infección activa por H pylori fue determinada usando la prueba de aliento con urea-13C (UBT). RESULTADOS: Cincuenta y dos niños resultaron positivos a la prueba de H pylori, para una prevalencia de 54.2%. La edad promedio de la población en estudio fue de nueve años, con un 46.9% de varones y un 53.1% de hembras. No se halló ninguna relación significativa entre el género, la lactancia materna, las mascotas, y la condición del H pylori. CONCLUSIÓN: La prevalencia reportada en este estudio es la más alta que se haya reportado en niños asintomáticos en el Caribe. Se requieren estudios ulteriores a fin de determinar los factores de riesgo que conducen a la infección por H pylori en esta población.

Prueba del aliento y hallazgos histopatológicos asociados a la infección por Helicobacter pylori / Urea breath test and histopathological features related to helicobacter pylori infection

Existen múltiples métodos para diagnosticar la infección por H. pylori. Se plantea correlacionar la prueba del aliento con los hallazgos histopatológicos en el antro asociados a la infección por H. pylori en la población de Mucuchíes. Se incluyeron 108 pacientes entre 18 y 75 años. Se realizó prueba del aliento con 14C y endoscopia digestiva superior con obtención de cuatro muestras de mucosa antral. Se determinaron la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN), y la concordancia con la biopsia, además de correlaciones entre los valores de la prueba con la histopatología. Se obtuvieron 74 pacientes copositivos, con una sensibilidad del 87,05%, y una especificidad del 73,91% para la prueba del aliento. El VPP fue del 92,5%, y el VPN fue de 60,71%. El Kappa fue de 0,56. Se encontró correlación lineal entre la prueba del aliento, la densidad y la histología. La prueba del aliento constituye una herramienta útil en el diagnóstico de la infección por H. pylori y sus manifestaciones histopatológicas asociadas

There are many methods to diagnose H. pylori infection. It is proposed to compare the cuantitative14C Urea Breath Test with the histopathological features in the antrum related to H. pylori in the population of Mucuchíes. 108 patients between 18 and 75 years were included to perform the 14C Urea Breath Test, and the upper digestive endoscopy with four biopsy samples obtained from the gastric antrum. The sensitivity, specificity, PPV, NPV and Kappa index were determined for the 14C Urea Breath Test, and correlations between the 14C Urea Breath Test and histological features were determined too. We obtained 74 copositive patients, with a sensitivity of 87,05% and specificity of 73,91% for the 14C UBT. The PPV was of 92,5% and the NPV was of 60,71%. The Kappa index was of 0,56. A linear correlation between the test and the histological features was found. The 14C UBT is a very useful tool in the diagnosis of H. pylori infection and its related histopathological features

Prueba de aliento optimizada con urea marcada con carbono 13 para la detección de Helicobacter pylori (PAU-Hp13C) / Optimized 13C-urea breath test for Helicobacter pylori detection (PAU-Hp-13C®)

Helicobacter pylori es una bacteria íntimamente relacionada con enfermedades benignas del estómago como la dispepsia no ulcerosa, la gastritis crónica, la úlcera péptica duodenal y gástrica, y con enfermedades malignas como el cáncer gástrico y los linfomas MALT del estómago...

Helicobacter pylori is a bacteria closely related to gastric benign diseases, such as nonulcerdyspepsia, chronic gastritis, gastric and duodenal peptic ulcer; it is also related with malignant neoplasms such as gastric cancer and gastric MALT lymphomas...

Validation of a rapid stool antigen test for diagnosis of Helicobacter pylori infection / Validação de teste rápido de antígeno fecal para diagnóstico de infecção por Helicobacter pylori

The aim of this study was to validate the rapid lateral flow Helicobacter pylori stool antigen test (One step H. pylori antigen test, ACON laboratories, San Diego, USA; Prime diagnostics, São Paulo), using 13C-Urea Breath Test as the gold standard for H. pylori infection diagnosis. A total of 98 consecutive patients, asymptomatic or dyspeptic, entered the study. Sixty-nine were women, with a mean age of 45.76 ± 14.59 years (14 to 79 years). In the H. pylori-positive group, the rapid stool antigen test detected H. pylori antigen in 44 of the 50 positive patients (sensitivity 88 percent; 95 percent CI: 75.7-95.5 percent), and six false-negative; and in the H. pylori-negative group 42 presented negative results (specificity 87.5 percent; 95 percent CI: 74.7-95.3 percent), and six false-positive, showing a substantial agreement (Kappa Index = 0.75; p < 0.0001; 95 percent CI: 0.6-0.9). Forty four of fifty patients that had positive stool antigen were H. pylori-positive, the PPV of the stool antigen test was 88 percent (95 percent CI: 75.7-95.5 percent), and 42 patients with negative stool antigen test were H. pylori-negative, the NPV of the stool antigen test was 87.5 percent (95 percent CI: 74.7-95.3 percent). We conclude that the lateral flow stool antigen test can be used as an alternative to breath test for H. pylori infection diagnosis especially in developing countries.

O objetivo desse trabalho foi avaliar o teste rápido de antígeno de H. pylori nas fezes (One step H. pylori antigen test, ACON laboratories, San Diego, USA; Prime diagnostics, São Paulo), usando teste respiratório com uréia marcada com 13C (TRU-13C), como padrão ouro. Noventa e oito pacientes assintomáticos ou com dispepsia participaram do estudo. Sessenta e nove eram mulheres; a média de idade dos pacientes foi de 45.76 ± 14.59 (14 a 79 anos). No grupo H. pylori positivo, o teste rápido detectou antígenos de H. pylori nas fezes em 44 dos 50 pacientes positivos (sensibilidade de 88 por cento; 95 por cento IC: 75.7-95.5 por cento), com seis falso-negativos; e no grupo H. pylori negativo, 42 apresentaram resultados negativos (especificidade de 87,5 por cento; 95 por cento IC: 74.7-95.3 por cento), com seis falso-positivos, mostrando concordância substancial (índice Kappa = 0.75; p < 0.0001; 95 por cento IC: 0.6-0.9). Quarenta e quatro dos 50 que tiveram teste de antígeno fecal positivo eram H. pylori positivos, sendo o VPP do teste 88 por cento (95 por cento IC: 75.7-95.5 por cento), e 42 pacientes com teste de antígeno fecal negativo eram H. pylori negativos, com VPN de 87,5 por cento (95 por cento IC: 74.7-95.3 por cento). Concluímos que o teste de antígeno fecal imunocromatográfico pode ser usado como alternativa ao teste respiratório para diagnóstico de infecção pelo H. pylori, principalmente em países em desenvolvimento.