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  • 1
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background. Antimicrobial susceptibility testing of Helicobacter pylori isolates is the most useful tool for guiding specific therapy, especially when primary resistance is suspected. However, the most informative gastric biopsy site for detection of resistant H. pylori isolates is uncertain. We sought to determine whether susceptibilities to commonly used antimicrobials (amoxicillin, clarithromycin, minocycline, and metronidazole) were related to biopsy site.Methods. H. pylori isolates were obtained from patients who had duodenal ulcer and had not received any therapy directed against H. pylori. Agar-dilution minimum inhibitory concentrations of each antimicrobial were compared between paired H. pylori isolates from the antrum and the proximal corpus.Results. Differences in minimum inhibitory concentrations exceeding twofold were observed within the pairs of H. pylori isolates in 5 of the 40 patients tested. In three patients with clarithromycin-resistant isolates and two with metronidazole-resistant isolates, both antral and corporeal specimens revealed resistance. However, no patient had pairs of isolates categorized as resistant at one site and sensitive at the other.Conclusions. While we found that an individual may have a mixed H. pylori infection with respect to differing antimicrobial susceptibility in different parts of the stomach, a single biopsy specimen from either the antrum or the corpus should provide reliable detection of H. pylori isolates with primary resistance.
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  • 2
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background. Long-term data concerning the reappearance of Helicobacter pylori infection and duodenal ulcer (DU) recurrence after successful eradication are still few and conflicting. Inadequate histological assessment or use of indirect tests for the determination of H. pylori and bias in the selection of patients to be controlled can influence reported results. The aim of this study was to determine the rate of recurrence of H. pylori infection and ulcer relapse in a population of cured DU patients followed up for 3 years irrespective of their symptomatology.Methods. Between 1992 and 1994, 126 patients with DU disease were treated with double or triple therapy. Patients using nonsteroidal antiinflammatory drugs or aspirin or receiving maintenance antisecretory therapy were excluded. H. pylori infection was assessed by three bioptic tests from both the antrum and the body (culture, urease, histopathological examination). After 2 months from cessation of treatment, DU had healed and H. pylori infection was cured in 102 of 126 patients (81%). These patients were endoscopically followed up after 1 and 3 years, respectively, and were advised to contact us at symptom recurrence. At 1 and 3 years, we studied 95 (93.2%) and 79 (77.4%) patients, respectively, of the 102 who were cured. The other patients were untraceable or refused endoscopy because they were asymptomatic.Results. After 1 year, no patient had H. pylori recurrence, whereas three patients had a relapse of DU without evidence of infection. After 3 years, recurrence of H. pylori occurred in six patients (annual rate, 2.5%), DU relapsed in five H. pylori–positive patients (6.3%) and in two H. pylori–negative patients (annual rate, 1.9%). Fasting gastrin and acid secretion values studied in all relapsed patients were within the normal range except for one H. pylori–positive patient.Conclusions. Recurrence of H. pylori infection is very low where treatment is effective, but a DU relapse, not related to acid hypersecretion, can occur in a small percentage of cured patients.
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  • 3
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective. Because in children Helicobacter pylori colonization could differ as compared to that in adults, gastric metabolism of urea and the reliability of the breath test must be evaluated. The aim of this study was to quantify the relationship between breath test and colonization.Methodology. We studied data from 50 endoscopies performed in 39 children and adolescents (20 girls, 19 boys, aged 3–18 years); 28 were infected with H. pylori. Biopsies were analyzed for histological and microbiological diagnosis of infection and for quantitative antral culture of H. pylori. A 13C urea breath test was performed on the same day as that of endoscopy ( n = 33) or delayed between 2 and 90 days ( n = 17).Results. Using a cut-off value of 3 δ‰, sensitivity was 96.5%, and specificity was 91.5%. The three children showing discrepancies between breath test and biopsy results had a δ‰ value close to the cut-off. For the 26 cases with a positive culture, we noted a significant correlation (r = 0.63; p 〈 .001) that was not affected by the delay between breath test and gastroscopy.Conclusion. This quantitative relation between bacterial density and δ‰ permits increasing the reliability of the test by interpreting carefully those results that approach the cut-off value.
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  • 5
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background. Data regarding the effectiveness of second-line treatment of Helicobacter pylori infection are limited, especially if microbiological studies are considered.Methods and Patients. We conducted a prospective, uncontrolled study of a consecutive series of 21 peptic ulcer patients with failure of 1-week lansoprazole, amoxicillin, and clarithromycin. H. pylori status was evaluated by urease test, histology, culture, and urea breath test. Susceptibility to amoxicillin, clarithromycin, and metronidazole was studied by E-test. Cure of infection was defined as negative results from endoscopy-based tests 1 month after treatment and negative results from a urea breath test at 2 months. Treatment consisted of a 1-week combination of lansoprazole (30 mg bid), tetracycline (500 mg qid), metronidazole (500 mg tid), and bismuth subcitrate (120 mg qid).Results. H. pylori was resistant to metronidazole in three cases, to clarithromycin in three cases, and to both clarithromycin and metroinidazole in an additional three patients. No resistance to amoxicillin was found. Eradication was obtained in 20 cases (95.2% confidence interval [CI], 76.2–99.9). The only patient in whom infection was not eradicated harbored a metronidazole-resistant (minimum inhibitory concentration〉 32 μg/ml) strain. No significant side effects were reported.Conclusion. Quadruple therapy obtains a high eradication rate even in patients with clarithromycin- and metronidazole-resistant strains. Further randomized and controlled studies are warranted and are urgently needed.
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  • 6
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Diagnosis of H. pylori infection may be made by endoscopic (invasive) tests, or by nonendoscopic (noninvasive) tests. Our aim was to evaluate recently available nonendoscopic tests, including two office-based serologic tests and a commercially available 13C urea breath test.〈section xml:id="abs1-2"〉〈title type="main"〉Methods.Gastric biopsy specimens (for culture and stain) from 178 patients (mean age 46 ± 13.3 years, 79 men and 99 women), none of whom had received anti-H. pylori therapy, were tested for H. pylori infection. These tests were compared against two commercial serum IgG antibody immunoassays (Biowhittaker’s Pyloristat, and Quidel), 2 office-based serum qualitative IgG antibody tests (FlexSure HP, and QuickVue One-Step), the Meretek 13C urea breath test, and the CLOtest (a biopsy urease test).〈section xml:id="abs1-3"〉〈title type="main"〉Results.The breath test (n = 147) had the best accuracy (96%) of the noninvasive tests studied. The serologic tests had similar accuracy to one another (84%–90%). The major drawback of the serologic tests was suboptimal specificity (75%–87%). Diagnosis of H. pylori based on the two office-based tests were not significantly different compared to the quantitative IgG antibody tests. The CLOtest had an accuracy of 97%.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusions.The Meretek 13C urea breath test is an excellent test, but is considerably more expensive than serologic tests. The FlexSure HP and the QuickVue One-Step office-based qualitative IgG serologic antibody tests gave similar results to laboratory based quantitative antibody tests, and are acceptable for initial diagnosis of H. pylori infection. The advantages of the office-based tests are low cost, simplicity, and immediacy of results.
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  • 7
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: About 60–70% of Helicobacter pylori strains possess cagA (cytotoxin associated gene A) gene and express its product CagA, a highly immunogenic 128–140kD protein. Patients infected with CagA positive strains develop serum IgG anti-CagA. A serologic response to CagA has been detected in Helicobacter pylori infected patients with peptic ulcer more frequently than in those with gastritis alone. It is unclear whether this finding is consistent in different geographical populations. We investigated the relationship between anti-CagA seropositivity and peptic ulcer disease in a Northern Italian population.〈section xml:id="abs1-2"〉〈title type="main"〉Materials and Methods.We studied 135 H. pylori infected patients: 65 with duodenal ulcer (DU), 28 with gastric ulcer (GU) and 42 with non ulcer dyspepsia (NUD). Sera from these patients were assayed by EIA (enzyme immunoassay) for anti-CagA IgG.〈section xml:id="abs1-3"〉〈title type="main"〉Results.A high prevalence of anti-CagA was found associated with DU (86.1%) and GU (96.4%), while NUD patients showed anti-CagA seropositivity of 52.4% (Odd ratio, 5.66; 95% confidence interval, 2.23 to 14.32;p~〈~.001, DU vs. NUD; Odd ratio, 24.5; 95% confidence interval, 3.05 to 197.6;p~=~.003, GU vs. NUD). DU patients showed anti-CagA seropositivity titer (1.15 (0.61 OD, mean (SD) higher than that of NUD patients (0.78 (0.60 OD, mean (SD) (p~〈~.05).〈section xml:id="abs1-4"〉〈title type="main"〉Conclusions.These data demonstrate in a Northern Italian population that anti-CagA seropositivity is strongly associated with peptic ulcer disease and suggest that CagA might play an important role in ulcer pathogenesis.
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  • 8
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background. The aims of our study were twofold. First, we sought to evaluate in symptomatic children the influence of the Helicobacter pylori genotype on gastritis, abdominal pain, and circulating anti–H. pylori IgG antibodies (anti–H. pylori IgG) or pepsinogen A (PGA) and C (PGC). Additionally, we sought to assess anti–H. pylori IgG, PGA, and PGC patterns in a large cohort (N = 921) of asymptomatic children.Materials and Methods. In 183 symptomatic children, H. pylori infection and the presence of gastritis were evaluated by histology. In a subgroup of 20 H. pylori–positive children, the H. pylori genotype was evaluated also by polymerase chain reaction. Nine hundred and twenty-one asymptomatic children, aged 11 to 14 years, were studied by anti–H. pylori IgG, PGA, and PGC serum determination.Results. The infection was found in 33 of 183 symptomatic children; among the 20 H. pylori–positive children for which the H. pylori genotype was available, cagA was present or absent in equal percentages. H. pylori infection was associated with more severe gastritis and higher serum levels of anti–H. pylori IgG and PGC but not with abdominal pain. In infected children, higher levels of anti–H. pylori IgG and the presence of abdominal pain were associated with infections caused by cagA-positive strains. In the cohort of 921 asymptomatic children, raised levels of anti–H. pylori IgG, PGA, and PGC were found in approximately 5% of the cases.Conclusions. Infection with cagA-positive H. pylori strains can be associated with increased frequency of reported abdominal pain and higher circulating levels of anti–H. pylori IgG. The serological assessment of H. pylori IgG using H. pylori antigens containing significant amounts of cagA protein may, therefore, underestimate the true prevalence of infection.
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  • 9
    Electronic Resource
    Electronic Resource
    Boston, MA, USA : Blackwell Science Ltd
    Helicobacter 4 (1999), S. 0 
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background. Peptic ulcer disease (PUD) is a problem common in family medicine. Recent evidence of Helicobacter pylori as an etiological agent of PUD has led to National Institutes of Health recommendations for treatment to eradicate H. pylori through antibiotic therapy. The purpose of this study is to examine practice patterns of family physicians in treating PUD, their use of H. pylori testing, and knowledge of current recommendations for PUD.Materials and Methods. A mail survey was sent to a random sample of 1,500 members of the American Academy of Family Physicians. Six hundred thirty useable surveys (49.1%) were available for analysis. Descriptive statistics were obtained, as were inferential statistics focusing on the relationship of physician background characteristics to practices.Results. Thirty-eight percent of the respondents order diagnostic procedures for the majority (50% or more) of their suspected PUD cases. Of the physicians who reported ordering any diagnostic tests, 52% ordered the combination of upper gastrointestinal series and endoscopic gastroduodenoscopy. For patients with clinical diagnoses of PUD, 77% of doctors reported ordering a diagnostic test for H. pylori. Approximately 68% were aware that some kind of guidelines existed; only 11% reported that they were familiar with the National Institutes of Health recommendations for PUD.Conclusions. Although some of the practices of family physicians for treatment of PUD deviate from current recommendations, the majority of practices are consistent with current evidence.
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  • 10
    ISSN: 1523-5378
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background. The aim of this study was to assess the correlation between the prevalence of Helicobacter pylori strains possessing cytotoxin-associated gene A (cagA) in children and the intensity of clinical complaints and morphological changes of the gastric mucosa.Materials and Methods. A group of 80 children with gastrointestinal complaints was included in this study. Pathologists examined mucosal biopsy specimens from these patients. The urease test and multiplex polymerase chain reaction (MPCR) were used to identify H. pylori strains.Results. In the group of children infected with cagA-positive H. pylori strains, fourth-degree gastritis was more frequent than in the group with cagA-negative H. pylori colonization. In histopathological assessment, infection with cagA-positive H. pylori was associated also with higher grades of inflammatory intensity and activity.Conclusions. Marked inflammation of the antral mucosa was significantly more frequent in children infected with cagA-positive H. pylori than in those infected with cagA-negative H. pylori, as assessed endoscopically and histopathologically. No specific symptoms for cagA-positive and cagA-negative H. pylori infection were observed.
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