Helicobacter Pylori Stool Antigen Research Articles

Effectiveness of Probiotic on Eradication Helicobacter Pylori Gastritis in Children

Background: Helicobacter pylori (H. pylori) is one of the causes of intestinal and gastric ulcers or one of the factors causing gastric malignancy. The prevalence of H. pylori infection is more than 80% in developing countries. Probiotics provide beneficial effects on the host?s health when administered in an adequate amount. Lactobacillus and Bifidobacteria are the most commonly used as probiotics. H.pylori colonization is interfered with by regular ingestion of L. acidophilus, and the urea breath test values decreased by approximately 10% four weeks after treatment. Objective: To assess the effectiveness of probiotic in eradication of H. pylori gastritis in children along with triple therapy Methods: This clinical trial design in children with H. pylori gastritis in a network hospital in Medan. Sampling was carried out from August 2019 - April 2020 with randomization techniques and double-blind in children suffering from H. pylori gastritis based on history, physical examination, H. pylori stool antigen (HpSA) test and endoscopy. Mc Nemar test analysis was performed to assess the difference effectiveness of drugs in the two groups. Result: From 33 children who received probiotics 31 children eradicated and from 31 children who did not receive probiotics, 29 children were eradicated. From 33 children who received probiotics, 6 children had side effects. From 31 children who did not receive probiotics, 22 children had side effects such as nausea/vomiting, abdominal pain, and diarrhea. There was no significant difference between probiotics and triple therapy with only triple therapy (p = 1,000). However, there was a significant difference in reducing the side effects of nausea/vomiting and diarrhea in the probiotic group (p = 0.015). Conclusion: There were no significant differences between administering probiotics plus triple therapy with triple therapy only to eradicate H. pylori gastritis in children. However, there were significant differences in the probiotic group in reducing the symptoms of side effects.

Diagnosis of Helicobacter pylori infection in the elderly using an immunochromatographic assay-based stool antigen test.

The diagnostic value of Helicobacter pylori stool antigen (HpSA) tests in elderly subjects remains unclear. The objective of this study was to assess the diagnostic accuracy of the immunochromatographic assay‐based HpSA test in a male elderly cohort and identify factors affecting the accuracy. Data for asymptomatic elderly male citizens (≥65 years old) who received health checkups at the Chinese PLA General Hospital between July 2007 and November 2018 were collected. The diagnostic accuracy of the HpSA test was determined using the 13C‐urea breath test as a reference standard. Associations between baseline comorbidities and the accuracy of the HpSA test were analyzed. In total, 316 participants were enrolled, including 193 in the pre‐treatment group (77.2 ± 7.8 years old) and 123 in the post‐treatment group (78.7 ± 8.3 years old). The accuracy (91.5%, 91.2%, and 91.9%) and specificity (97.6%, 98.7%, and 96.0%) were high in all participants, pre‐ and post‐treatment groups, respectively. However, sensitivities were only 68.7%, 65.1%, and 75.0%, respectively. In the pre‐treatment group, constipation was associated with decreased sensitivity (p = 0.039), while colorectal polyps were associated with increased sensitivity (p = 0.010). Multivariate analysis indicated that constipation and colorectal polyps are independent factors for the sensitivity of HpSA in the pre‐treatment group. The immunochromatographic assay‐based HpSA test achieved high accuracy with high specificity but suboptimal sensitivity in the elderly male cohort. Constipation and colorectal polyps were negatively and positively associated with HpSA sensitivity, respectively, in the pre‐treatment group.

Helicobacter pylori CagA seropositivity in adult Bangladeshi patients with peptic ulcer and erosion

Background: CagA IgG antibody in sera might indicate presence of virulent Helicobacter pylori in patients with peptic ulcer disease. Present study was performed to find out the prevalence of CagA IgG antibody in patients with peptic ulcer/erosion.
 Methods: Any case that had peptic ulcer/erosion, plus positive for rapid urease test (RUT) or H. pylori stool antigen (HpSAg) or serum anti-H. pylori IgG/IgA were included in the study and named as H. pylori positive case. H. pylori positive cases were tested for CagA IgG antibody. Anti-H. pylori IgG, IgA and CagA IgG antibodies were determined by enzyme-linked immunosorbent assay (ELISA) and stool antigen by rapid immunochromatographic test (ICT). Urease production in biopsy sample was detected by RUT.
 Results: Total 86 H. pylori positive patients were included in the study. Out of 86 patients, CagA IgG was positive in 34 (39.5%; 95% CI: 0.30,0.50) cases. CagA seropositivity rate in ulcer and erosion cases were 58.8% (95% CI: 0.36,0.78) and 34.8% (95% CI: 0.25,0.47) respectively. H. pylori stool antigen and IgA antibodies were positive in all (100%) CagA antibody positive ulcer cases while the rates were significantly less among the CagA antibody negative cases (42.8% and 28.6%; p<0.05). However, in CagA antibody positive erosion cases, the rates were not significantly different from CagA antibody negative cases.
 Conclusion: The study has demonstrated that the CagA positive strain is less prevalent in erosion than ulcer cases.
 Ibrahim Med. Coll. J. 2020; 14(1): 36-40

Helicobacter pylori as a risk factor for gastric cancer: the evidence and primary prevention strategy

Russia is a country with a high prevalence of Helicobacter pylori (HP) infection, a high incidence of gastric cancer, and its late diagnosis. HР infection has been recognized as the leading manageable risk factor for gastric cancer. Accurate diagnostic tests must be used to identify and control the effectiveness of HP eradication, and effective schemes must be implemented for HP eradication. The aim of this article was to analyze the latest consensus documents, systematic reviews and meta-analyzes that reflected the role of HP as a risk factor for the development of gastric cancer, as well as measures for the risk reduction. We describe in detail the diagnostic methods for HP infection, provide data on their use in the Russian Federation, and analyze the efficacy of eradication regimens. In all HPinfected individuals, HP leads to chronic inflammation in the gastric mucosa and launches a precancerous cascade (Correa's cascade). The risk of gastric cancer increases with severe atrophy, intestinal metaplasia and dysplasia. Primary prevention of gastric cancer is most effective if the eradication is performed before atrophic gastritis develops. The available consensus documents underline the importance of HP infection identification by accurate diagnostics at this stage of chronic gastritis. In Russia, the primary HP diagnosis is based on histology (37.7%), rapid urease test (29.2%), and serology (29.7%). HP stool antigen test (31.3%), 13C-urea breath test (23.4%) and the histological method (23.3%) are most often used to control eradication. Currently, the first line of eradication therapy is recommended as triple therapy with clarithromycin prescribed for 14 days. It is recommended to use double dose of proton pump inhibitors and bismuth to increase the effectiveness of this scheme. A 14-days triple regimen enhanced by bismuth has been recommended as the first-line therapy in the Russian Federation.

The Effect of Red Rose Extract on Helicobacter Pylori Eradication: A Randomized Controlled Clinical Trial

Background Helicobacter pylori (H. pylori) is believed to be the most common bacterial infection worldwide. Herein, we aimed to investigate the effect of red rose extract on H. pylori eradication in 9 to 15 year-old children. Materials and Methods In this randomized controlled clinical trial,by the convenience sampling method 332 children were screened for H. pylori infection. Their stool samples were studied by the H. pylori Antigen Enzyme Immunoassay (EIA) Test Kit. Positive cases were divided into two groups and received either red rose extract or placebo for 14 days. The stool exam was repeated once again at treatment termination. Data were analyzed using SPSS software (version 21.0). Results In total 17.8% (n=59) of the 332 cases were positive for Helicobacter pylori stool antigen (HpSA), and 56 completed the study. The mean HpSA titer remained stable in the red rose extract treated group but it increased in the placebo group following intervention; however, the difference was statistically insignificant (p=0.57). Moreover, the intervention resulted in no difference in the eradication rate between the two groups (p=0.57). Conclusion Red rose extract did not reduce HpSA titer after intervention, so it cannot be solely considered as an alternative for H. pylori eradication. Further studies with a different dose and duration or with combined regimens are recommended.

1232 Factors Associated With Treatment Failure in Biopsy Proven Helicobacter pylori Infection in the Rio Grande Valley: A Retrospective Review of 3 Years Data

INTRODUCTION: The 2017 American College of Gastroenterology Clinical guidelines advocate clarithromycin triple therapy (CTT) as first line H. Pylori (HP) treatment. CTT consists of a 14-day course of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole. The national CTT eradication rate (ER) nears 80%. Many well-established factors affect treatment success including therapy duration, compliance, smoking, diabetes mellitus (DM), and local antibiotic resistance rates. Efficacy data on CTT in the Rio Grande Valley (RGV) has not been previously described. It is assumed that local resistance rates parallel those of our neighboring country due to proximity which may influence clinical practice. Aim is to determine the factors that affect biopsy-proven HP treatment failure. METHODS: A retrospective analysis of patients treated for HP in one RGV gastroenterology center between 2015 and 2018 was done. Eradication was defined by either a negative 13C Urea breath test or by a negative HP stool antigen test after treatment. ER was calculated for each regimen and compared against therapy duration, smoking, DM, health insurance status, and socioeconomic level; the latter determined by patient zip codes. We calculated raw ORs (95% CI) and adjusted with Cox and binary logistic regression. RESULTS: Of 544 patients, 71% (384) were females and 97% (526) were Hispanic. Nonsmokers were 79% (425) and diabetics were 32% (174). In total, 56% (305) received CTT and 44% (239) received quadruple therapy (QT) (ie., Tetracycline, metronidazole, bismuth, any PPI). ER was 66% for CTT and 62% for QT. Regarding both therapies, no treatment failure difference was found (P = 0.62) at 10 days, however, treatment failure decreased with 14-day therapy (P < 0.001). Regarding health insurance, 84% (452) had private, 13% (72) had government-issued, and 3% (16) were self-pay. Cox regression found no differences in treatment type. Logistic regression found that females OR 2.25 (95% CI 1.4, 3.5, P < 0.001), income <$40,000/year OR 1.78 (95% CI: 1.1, 2.8, P = 0.013), and smoking OR 1.6 (95% CI 1.03, 2.6, P = 0.034) negatively affected eradication. CONCLUSION: HP therapy efficacy was suboptimal, however, 14-day therapy improved treatment failure. More females were affected with HP. Factors negatively affecting eradication were female gender, smoking, and income <$40,000/year. Further studies are required to determine the role of patient education, HP local antibiotic resistance patterns, and physician practice on HP eradication.

Application of Helicobacter pylori stool antigen test to survey the updated prevalence of Helicobacter pylori infection in Taiwan.

The reported prevalence of Helicobacter pylori infection in Taiwan was 54.4% in 1992. An updated prevalence of H.pylori infection in asymptomatic adults is lacking in Taiwan. We aimed to assess the updated age-standardized prevalence of H.pylori infection in asymptomatic subjects and in patients with dyspepsia and to assess the accuracy of H.pylori stool antigen (HpSA) test for screening of H.pylori in Chinese population. Asymptomatic adult subjects (N=189) were screened for H.pylori infection using HpSA, serology, and 13 C-urea breath test (13 C-UBT) in 2016-2017. Adult patients with dyspepsia (N=145) were screened for H.pylori using 13 C-UBT, HpSA, serology, rapid urease test, and histology during 2016-2018. Two types of HpSA, including the Diagnostec HpSA ELISA Kit (HpSA ELISA) and Rapid Test Kit (HpSA Rapid), were used in this study. Sensitivity, specificity, and accuracy of the HpSA tests were calculated using the 13 C-UBT as golden standard test. The unadjusted prevalence of H.pylori was 21.2% in asymptomatic adults and 37.9% in patients with dyspepsia (P<0.001). The age-standardized prevalence of H.pylori was 28.9% in asymptomatic adults in Taiwan. Of the 334 patients included for analysis, the area under the curve of HpSA ELISA test was 0.978, and the optimal cutoff value of optical density was 0.03. The sensitivity, specificity, and accuracy of the HpSA ELISA were 0.929, 0.983, and 0.967, respectively. The sensitivity, specificity, and accuracy of the HpSA Rapid were 0.929, 0.958, and 0.949, respectively. The prevalence of H.pylori infection has decreased in Taiwan. HpSA test is an accurate tool for screening of H.pylori in Chinese population.

Standard triple therapy in Helicobacter pylori eradication in Turkey: Systematic evaluation and meta-analysis of 10-year studies.

This study aims at evaluating the mean eradication rate by a systematic compilation of the studies which involved the standard triple therapy (STT) in first-line Helicobacter pylori (Hp) eradication in Turkey over a period of 10 years between 2004 and 2013 using the meta-analysis method. The systematic compilation and meta-analysis were carried out according to the PRISMA standards defined in the Cochrane handbook. The results of full-text studies published in national and international journals in English and Turkish languages on Turkish population in a period of 10 years, from 2004 to 2013, are included in this study. The studies include open-label trials, controlled trials, treatment arms, and case series that included a triple therapy regimen consisting of standard doses of a proton pump inhibitor (PPI; omeprazole 20 mg BID, lansoprazole 30 mg BID, pantoprazole 40 mg BID, esomeprazole 40 mg BID, or rabeprazole 20 mg BID) along with clarithromycin 500 mg BID and amoxicillin 1 g BID for 7-14 days. They were scanned electronically via the search engines Google Scholar, PubMed, and the Turkish Medicine Index using specific keywords. The related keywords used were Turkey, Helicobacter pylori, infection, standard triple treatment, first-line therapy, eradication, omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, clarithromycin, and amoxicillin. Studies carried out with adults were included in the evaluation. The publication year of the studies and the included number of patients, their age, gender, treatment duration (7, 10, and 14 days), and PPIs used were evaluated by two separate gastroenterologists and biostatisticians. Studies that used at least one reliable method (histology, urea breath test (UBT), or Helicobacter pylori stool antigen (HpSA) test) four weeks after completing the treatment for the control of Hp eradication were included. Only naive patients were accepted, and patients who had previously received eradication treatment were excluded. The effectiveness of the Hp eradication was analyzed using an intention-to-treat (ITT) or per-protocol (PP) analysis. The STT regime of 45 studies complying with the inclusion criteria was evaluated. A total of 3715 patients were included in the study. Of the 3010 patients whose gender information was available, 55% were women and 45% were men; the weighted age average given explicitly in the studies was 42.14±0.67. The treatment lasted for 14 days in 42 studies, for 7 days in six studies, and for 10 days in 1 study. The eradication rates evaluated according to the ITT and PP analyses were 60% (95% CI: 56%-63%) and 57% (95% CI: 51%-62%), respectively. The rates for 7 days of treatment were 57% (95% CI: 46%-68%) and 60% (95% CI: 51%-67%) and for 14 days of treatment were 60% (95% CI: 56%-63%) and 56% (95% CI: 50%-62%), respectively. The ITT eradication rate of the only 10-day study was 78% (95% CI: 66%-86%). In the meta-regression analysis, the treatment duration, PPI, age, and gender ratio (women/men) used for the ITT analysis had no effect. The gender ratio and age were not considered in this analysis because they were not clearly stated in studies using the PP analysis. The duration of treatment and the PPI used had no effect. A systematic meta-analysis of studies conducted during the period 2004-2013 in Turkey revealed that the rate of first-line Hp eradication using STT was unacceptably low, and the duration of treatment and PPI used made no difference.

Diagnostic value of platelet indices, carbohydrate antigen 19-9 and carcinoembryonic antigen in differentiating malignant from benign gastric ulcers

Objective To elucidate the value of platelet indices, carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) in differentiating malignant from benign gastric ulcers. Background Gastric cancer is one of the most common malignant diseases and benign gastric ulcer is a worldwide disease, responsible for substantial premature mortality. Clinical symptoms of early gastric cancer could not be used to distinguish gastric cancer from ulcers. Platelet indices: mean platelet volume (MPV) and platelet distribution width (PDW) are a group of platelet parameters investigated as platelet activation indicators. Patients and methods This prospective study included 150 patients: 30 patients with malignant gastric ulcer, 60 patients with benign gastric ulcer, and 60 healthy control participants. Upper endoscope with tissue biopsy and pathological evaluation, Helicobacter pylori stool antigen, platelet count, PDW, MPV, CEA, CA 19-9, computed tomography scan of the chest, abdomen, and the pelvis were assessed. Results Platelet count, MPV, PDW, CEA, and CA 19-9 were significantly higher in malignant gastric ulcer patients than benign ulcer patients and controls. MPV and PDW showed sensitivity, specificity, and area under the curve (93.3, 70 and 0.934% and 96.7, 86.7 and 0.966%, respectively) in predicting malignancy in gastric ulcer patients with improved diagnostic accuracy when combined with CEA and CA 19-9. Higher platelet count and PDW were significantly associated with advanced clinicopathological parameters of gastric cancer. Conclusion Changes in platelet indices are valuable markers in predicting malignancy in gastric ulcer patients. Significant increase in platelet count and PDW correlate and could be reliable markers, together with other markers of gastric cancer (CEA and CA 19-9), for clinicopathological features of malignant gastric ulcer.

Evaluation of Helicobacter pylori stool antigen test in comparison with conventional methods in detection of helicobacter pylori infection in dyspepsia patients

Background: Helicobacter pylori colonize the human stomach and is associated with gastritis, gastric and duodenal ulcers, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Owing to its momentous pathogenic role, the diagnosis of H pylori infection remains a subject of interest. Helicobacter can be detected by invasive and non invasive methods. Aim: The purpose of this study was to evaluate the accuracy of stool antigen test as a non invasive method for the diagnosis of H pylori infection. Materials and Method: A prospective study was conducted in a tertiary medical college hospital. Patients presenting with dyspeptic symptoms were subjected to endoscopy and investigated for H pylori infection through rapid urease test, histopathology and culture. Stool samples were also collected from these patients and tested for H pylori infection by a rapid Hpylori Stool Antigen test. H pylori status was defined as positive when both rapid urease test (RUT) and histopathology were positive or culture alone was positive for biopsy based invasive methods. Similarly a positive rapid HpSA test also indicates H pylori infection. Results: Of the 100 patients tested, 63 were H pylori infected by the endoscopy based invasive methods, and 54 by the non-invasive rapid HpSA test. The sensitivity, specificity and accuracy of H pylori stool antigen test were 85.7%, 88% and 91% respectively. Conclusion: The rapid HpSA test could be used as a noninvasive diagnostictest for H pylori infection.

Helicobacter pylori infection in family members of patients with gastroduodenal symptoms. A cross-sectional analytical study.

Primary Helicobacter pylori (H. pylori) infection is acquired predominantly in childhood in the family setting. We aimed to investigate the presence of intrafamilial concurrent H. pylori infection. Cross-sectional analytical study with a control group, conducted in a tertiary care hospital. Fifty adult patients with gastroduodenal symptoms who underwent gastroscopy (index parents), their spouses and their children were enrolled in the study. Blood samples were collected from all of the study subjects to test for immunoglobulin G (IgG) antibody response. H. pylori antigen was investigated in the stool specimens of children only. The participants were divided into two groups: Group 1 consisted of the 40 patients in whom H. pylori infection was demonstrated via endoscopy, their spouses and their children. Group 2 included the remaining 10 patients who underwent endoscopy revealing negative results for H. pylori, their spouses and their children. IgG antibodies were present in all of the index parents, 95% of their spouses and 93% of their children in group 1; 13 of the children (9%) were also positive for H. pylori stool antigen (HpSA). However, IgG antibodies were present in only 2 of the 10 index parents in group 2. One of their spouses and one of their children had a positive antibody response. All of their children had negative stool antigen test results. H. pylori infections exhibit intrafamilial clustering. Parental infection, age ≥ years and having three or more siblings are the major risk factors for H. pylori infection in children.

Diagnostic Accuracy of Latex Agglutination Turbidimetric Immunoassay in Screening Adolescents for Helicobacter pylori Infection in Japan

Background/Aims: Serologic tests are commonly used for screening Helicobacter pylori infection because they not only provide quick results but also are inexpensive. A new latex agglutination serum antibody assay (LZ test) has been developed and it is expected to be as effective as conventional assays. This study aimed to calculate a reliable cutoff value for the LZ test and to estimate the sensitivity and specificity of the cutoff value in screening adolescents for H. pylori infection in Japan. Methods: We screened junior high school students in Akita Prefecture, Japan, for H. pylori infection. We used the data of 213 such students who underwent H. pylori stool antigen (HpSA) tests in 2016. The students who had positive results with HpSA tests were diagnosed with H. pylori infection. Of the 213 students, 209 underwent the LZ test. Results: The prevalence rate of H. pylori infection was 3.8% (8/209). The area under the curve for the LZ test was 0.88. The cutoff value of the LZ test was determined to be 3.1 U/mL. At this value, the sensitivity and specificity were 87.5 and 91.5%, respectively. Conclusion: The accuracy of the LZ test in adolescents was well balanced for sensitivity and specificity as well as for tolerable results.

Analyzing the Abundance of the Gene glmM in Subjects with a Positive Helicobacter pylori Stool Antigen Test (HPSA) and Correlating glmM Abundance with Serum Levels of Cytokines TNF-α and IL-1β

Introduction: One of the most common genes in Helicobacter pylori is glmM which is usually used for identification of infection with the bacterium within gastric biopsy specimens by PCR, as a target gene. The aim of this study was to examine the prevalence rate of glmM gene in DNA samples of stool and evaluate its relationship with the fluctuations of serum levels of TNF-α and IL- 1β. Materials & methods: In this study, blood and stool samples were collected from 82 subjects in two groups with positive and negative HPSA test referred to laboratories of Ilam, Iran. PCR was used to investigate the presence of glmM gene in DNA extracted from stool samples, and then serum levels of studied cytokines were measured using specific kits by ELISA, and the results were analyzed using statistical tests. Findings: Analysis of data obtained from the study showed that the frequency of glmM gene in the sample of cases with positive HPSA was 23.8%, and there was a significant relationship between the presence of this gene in stool and fluctuations in serum levels of TNF-α and IL- 1β (P less-than 0.05). Disussion & conclusion: According to data, it can be said that the presence of glmM gene was associated with fluctuations in any of the variables of HPSA, TNF-α and IL- 1β and the possible presence of the gene in the stool raises with increase in each unit of HPSA and IL- 1β, which in turn raises the prognosis of diseases with a virulence form of bacteria by both serology and stool methods.

Relation between Hepatitis C Virus and Helicobacter Pylori in Non-Hodgkin's Lymphoma Patients

Background : It has been recently hypothesized that Helicobacter pylori (H. pylori) and Hepatitis C virus (HCV) might be involved in the pathogenesis of malignant non-Hodgkin's lymphoma (NHL) . Objective : is to assess if there is a relationship between Helicobacter pylori and Hepatitis C virus infection and malignant non-Hodgkin's lymphoma. Methodology: The study was performed on 100 adult NHL patients, newly diagnosed cases, at clinical pathology department; Faculty of medicine, Al-Azhar university from December 2015 to July 2017. Fifty apparently healthy relative individuals were studied as the control. We searched for H. pylori stool antigen using an enzyme immunoassay (EIA) procedure. HCV was investigated by EIA to detect its antibodies, reverse transcriptase polymerase chain reaction (RT-PCR) for the presence of its RNA and viral sequencing for the determination of the viral vireamia. Results: H. pylori stool antigen detected by the ELISA technique was found in 54/100 of the cases (54.0%) and (28.0%) of the controls with a p value <0.001. Correlation between H. pylori and different clinical and pathological data revealed that; there was a statistical significant correlation between patients complaining of fatigue, fever and the positivity of H. pylori (p-value <0.001). HCV antibodies detected by the ELISA technique were found in 35/100 patients and in 10/50 of controls with a p-value <0.001. Hepatitis C Virus antibodies and Helicobacter pylori stool Antigen were equally distributed among clinical and pathological parameters in Non-Hodgkin's Lymphoma cases. There was an overlap between both infections in eleven (11) of the 100 patients reactive for HCV antibodies were also positive for H. pylori stool antigen. Conclusion : H.pylori and HCV infection may have a role in the pathogenesis of non- Hodgkin lymphoma

Role of Helicobacter Pylori stool antigen test in the diagnosis of Helicobacter Pylori infection

Introduction: Helicobacter pylori (H. pylori) infection is common in developing countries. There are various invasive and non-invasive methods for diagnosing H. pylori infection. Stool antigen test is a new non-invasive method to diagnose H. pylori infection. In this study we evaluated the diagnostic accuracy of HpSA for H. pylori infection in patients with gastrointestinal (GI) complaints. Methods: Sixty patients including 28 men and 32 women with mean age of 49.2 ± 19.8 years undergoing diagnostic endoscopy with 30 positive and 30 negative rapid urease test (RUT) and histology results for H. pylori infection were evaluated. H. pylori stool antigen test (HpSA) was measured in these patients and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for HpSA were calculated. Results: Among 31 positive HpSA results, 2 were negative in RUT and histology and among 29 negative HpSA results, 1 was positive in RUT and histology results. Sensitivity, specificity, PPV, NPV and accuracy for HpSA in diagnosing H. pylori infection were 96.67%, 93.33%, 93.55%, 96.55% and 95%, respectively. Conclusion: Although the sensitivity and specificity of the HpSA are evaluated in a relatively small sample size, these results showed that HpSA is a useful test in diagnosing H. pylori infection in patients with upper GI complaints.

Deteksi Resistensi Amoxicillin Helicobacter pylori pada Pasien Dispepsia

Amoxicillin is one of the antibiotics that commonly used on treatment of H. pylori infection. pbp1A gene mutation in H. pylori is a dominant cause of amoxicillin resistance. This study was aimed to evaluate the presence of H. pylori in patients with dyspepsia by using non-invasive method i.e. H. pylori stool antigen (HPSA) and invasive method i.e. pbp1A gene amplification, and also evaluate the amoxicillin resistance of H. pylori by assessing the pbp1A gene mutations. The samples were 26 faeces and 26 gastric biopsies of patients with dyspepsia from the Internal Disease of Prof. Dr. Margono Soekardjo Hospital in Purwokerto. DNA amplification performed by using polymerase chain reaction (PCR) to detect the presence of amoxicillin resistance encoding gene i.e. penicillin binding protein (pbp1A). Sequencing of the DNA sample was performed at the First Base Malaysian Company, to analyze the existence of a point mutation. DNA sequencing analysis of 12 samples showed the presence of a mutations in pbp1A gene from 2 samples, in the third motive of pbp i.e. amino acid changes, Alanine 599 substituted to Threonin and Threonin 592 to Alanine. Those mutations become a dominant risk factor for resistance of H. pylori, toward the bacterial peptidoglycan synthesis. In this research, it was known that the detection of H. pylori infection by using PCR remains more accurate and specific method. The presence of H. pylori mutant strains in this study may becomes the risk factors of resistance to amoxicillin treatment.

Comparison of Standard Triple Therapy Regimen with Sequential Therapy Regimen Containing Levofloxacin Used for the Eradication of Helicobacter Pylori in Patients with Gastrointestinal Infection Caused by Helicobacter Pylori

Objectives: The aim of this study was to compare standard triple therapy regimen with sequential therapy regimen containing levofloxacin used for the eradication of H. pylori in patients with gastrointestinal infection caused by H. pylori. Methods: This single blind clinical trial study was conducted on 96 patients with positive Rapid Urease Test (RUT) who were referred to the Endoscopy center of Hajar Hospital in Shahrekord city, located in southwest of Iran. The patients were randomly assigned into two treatment groups: sequential therapy regimen and triple therapy regimen. The patients in the first group received sequential therapy regimen including omeprazole, amoxicillin, levofloxacin, and tinidazole; the second group of patients received a triple therapy regimen consisting of omeprazole, amoxicillin, and clarithromycin. Four weeks after the end of the treatment, using H. pylori Stool Antigen (HpSA), a test was performed to prove the eradication of H. pylori. The influences of patients’ age, gender and eradication level were also investigated. Results: There were significant differences between the two groups in terms of age and education. While H. pylori eradication rate was 67.3% in the sequential therapy regimen, it was 66% in standard triple therapy regimen. In addition, among patients receiving triple therapy regimen, being aged older than 40 years had a significant relationship with eradication. Moreover, in patients receiving sequential therapy regimen, education level had a significant relationship with eradication. Conclusion: There was no statistically significant difference between the two therapy groups in terms of H. pylori eradication rate. However, given the low rates of H. pylori eradication in both sequential and triple therapy regimens observed in the present study, it seems that it is necessary to conduct further research on the bacterial resistance to the prescribed antibiotics

Screening of Helicobacter pylori in alopecia areata patients

Objectives The aim of the present study was to clarify whether Helicobacter pylori plays a role in the pathogenesis of alopecic areata or not. Background Alopecia areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes. H. pylori has been associated with many extradigestive dermatological conditions. The causal relation between AA and H. pylori is discussed in this study. Patients and methods We screened patients with AA for the presence of H. pylori to determine any potential role in its pathophysiology. We prospectively studied 30 patients with AA and 20 healthy volunteers (control group) of similar sex for the presence of H. pylori stool antigen (HpSAg) (which is available according to the protocol) from February 2015 to January 2016 at El-Bagour Central Hospital. Results The values for H. pylori infection were positive in 25 of the 30 (83.3%) patients evaluated, whereas in five (16.7%) patients, the values did not support H. pylori infection. In the control group, seven out of 20 (35%) had positive results. There was a high significant difference between the patients (83.3%) and control (35%) groups as regards positivity of HpSAg. Furthermore, as per the quantitative estimation of the level of HpSAg. In the two groups, it was found to be significantly elevated with mean ± SD 1.73 ± 0.88 U/ml for patients and 1.04 ± 0.85 for controls (P = 0.009). Conclusion H. pylori infection may play a role in the pathogenesis of AA.

Helicobacter pylori cytotoxin-associated gene A genotype in Egyptian patients with Parkinson’s disease: could eradication benefit?

Strong growing evidence supports a link between Helicobacter pylori (HP) infections and Parkinson’s disease (PD). The purpose of this study was to explore the association between infection with HP cytotoxin-associated gene A (cagA) genotype and PD in Egyptian patients and the influence of its eradication on pharmacokinetic and clinical response to l-dopa. This study was performed on 87 idiopathic PD patients and 45 age- and sex-matched controls. HP infection was diagnosed with HP stool antigen test and HP cagA genotype was detected by PCR. PD patients were subjected to UCLA parkinsonism scale, Hoehn and Yahr staging, and l-dopa plasma level detection by high-performance liquid chromatography. HP PD patients were divided into eradicated group (received standard anti-HP therapy) and placebo group (received antioxidant therapy). Four weeks after therapy, patients were reevaluated. Among PD patients, frequency of HP infection was significantly higher than controls (55.2 vs 33.3%, P = 0.02), especially with HP cagA strain (81.2 vs 40%, P = 0.002). PD was more severe in HP infected (P < 0.001), especially in HP cagA-positive patients (P = 0.04) with significant lower l-dopa plasma levels (P < 0.001). cagA strains were associated with higher risk of increased PD severity (OR, 2.139; P = 0.029). Opposing antioxidant therapy, HP eradication treatment improved PD severity (UCLA score decreases by 30%) and increased l-dopa level by 40%. There is a proved link between PD and infection with virulent HP cagA strains. HP could affect l-dopa level by mechanisms other than reactive oxygen radical’s production which need further evaluation.

Evaluation of Rapid stool antigen test for the diagnosis of Helicobacter pylori infection in patients with dyspepsia

Background and objectives: Several diagnostic assays are used for the detection of Helicobacter pylori infection in suspected peptic ulcer cases. H. pylori stool antigen test is a non-invasive method for the detection of active infection. The present study has evaluated the efficacy of rapid stool antigen test to diagnose H. pylori infection in patients with dyspepsia.Materials and methods: Adult patients with complains of dyspepsia attending the Department of Gastroenterology, Hepatobiliary and Pancreatic Diseases (GHPD) of BIRDEM hospital for endoscopy were included. Gastric biopsy, blood and stool samples were obtained from each participant after informed written consent. Rapid urease test (RUT), serum H. pylori immunoglobulin A (IgA) and IgG and rapid H. pylori stool antigen (HpSAg) tests were performed. Only stool samples were obtained from 31 neonates aged 1 to 30 days as negative control for HpSAg test.Results: A total of 91 adult patients with complain of dyspepsia were included in the study. Out of 91 cases, 17 (18.7%) and 74 (81.3%) had peptic ulcer and erosion respectively. HpSAg was positive in 63.7% cases compared to 42.9% and 62.6% respectively by RUT and IgA. The rate of HpSAg positivity was significantly higher (p&lt;0.05) in ulcer compared to erosion cases. HpSAg test was positive in all (100%) RUT positive cases. Combination of HpSAg test and IgA yielded highest positive result in both ulcer (82.4%) and erosion (84%) cases. H. pylori IgG was positive in all cases.Conclusion: The study has demonstrated that HpSAg test is an effective and non-invasive diagnostic tool to detect active H. pylori infection in suspected dyspeptic patients.IMC J Med Sci 2016; 10(2): 39-44