This document discusses recent developments in the diagnosis of Helicobacter pylori (H. pylori) infection. It describes studies evaluating the diagnostic accuracy and contribution of endoscopy techniques like magnifying endoscopy and chromoendoscopy. It also discusses the optimal biopsy sites for histological diagnosis of H. pylori according to different clinical settings and the adequacy of routine special staining. Culture remains the gold standard for antibiotic susceptibility testing while molecular methods have gained attention for detecting antibiotic resistance. Overall, the document provides an overview of advances in both invasive and non-invasive diagnostic methods for H. pylori infection.
This document discusses the use of multiplex nucleic acid amplification tests (NAATs) to diagnose infectious diarrhea. It notes that traditional diagnostic methods have low sensitivity and long turnaround times. Multiplex NAATs allow simultaneous testing of stool for multiple pathogens, with higher sensitivity and shorter turnaround. However, they cannot provide antibiotic susceptibility or confirm identifications. The document reviews the pathogens detected by five FDA-approved multiplex NAAT platforms and notes their limitations, such as inability to distinguish carriers from infections or serotypes. It concludes that interpretation requires acknowledging limitations and clinical judgment, and more studies are needed on their cost-effectiveness and impact.
Development and validation of a novel diagnostic nomogram to differentiate be...Hidert Chusi Huamani
This study developed and validated two novel diagnostic nomograms to differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) using data from 310 patients across six hospitals in China. Eight variables were identified as valuable for establishing diagnostic models, including age, transverse ulcer, rectum involvement, skipped involvement of small bowel, target sign, comb sign, and interferon-gamma release assays or purified protein derivative test results. Two highly accurate nomograms were developed, with one showing 87.8% accuracy and the other showing 87.8% accuracy in differentiating CD from ITB. The nomograms provide a practical tool for clinicians to identify difficult cases of CD or ITB.
This document provides an overview of Helicobacter pylori infections. It discusses that H. pylori is the most common bacterial infection worldwide, affecting 70-90% of populations in developing countries. While most infections are asymptomatic, H. pylori can cause peptic ulcer disease in 10% of individuals and gastric cancer in 1%. The document outlines the microbiology of H. pylori, describing it as a gram-negative, microaerophilic spiral bacterium. It also discusses the pathogenesis of H. pylori infections and indications for testing. Treatment guidelines and various testing methods like invasive biopsy-based testing and non-invasive breath and stool antigen tests are also summarized.
This document reaffirms guidelines for diagnosing and managing urinary tract infections (UTIs) in infants and children ages 2-24 months. Key points include:
1) A urine specimen should be obtained through catheterization or suprapubic aspiration before starting antibiotics to accurately diagnose a UTI.
2) Clinical monitoring without testing is sufficient for febrile infants at low risk of UTI. For those at higher risk, urinalysis can guide need for culture.
3) Establishing a UTI diagnosis requires urinalysis showing infection and culture of ≥50,000 colony-forming units of a uropathogen from a properly obtained urine specimen.
4) Choice of antibiotic
This clinical practice guideline from the American Academy of Pediatrics provides recommendations for the diagnosis and management of initial urinary tract infections in febrile infants and young children aged 2 to 24 months. Key recommendations include:
1) If antimicrobial therapy is required urgently due to the infant's condition, a urine specimen must be obtained through catheterization or suprapubic aspiration before treatment to allow for accurate diagnosis of UTI.
2) For infants assessed as not requiring immediate treatment, clinicians should determine the likelihood of UTI based on specified risk factors. Low-risk infants require only clinical follow-up, while others should have urine tested or undergo ultrasound imaging of the kidneys and bladder.
3
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
1) A case-control study was conducted in Trinidad and Tobago to investigate a Salmonella outbreak occurring from 1988-1989. The study found that eating dishes containing raw or undercooked eggs was associated with Salmonella infection, with an almost 19 times higher risk among case patients.
2) Analysis of Salmonella isolates from 1988-1997 showed increases in S. Typhimurium and "Other" isolates initially, but S. Enteritidis became the dominant serotype starting in 1993. The highest infection rates were in children ages 0-4.
3) A seasonal pattern was observed, with peaks in Salmonella cases in May, December, and January each year from 1995-1997. This coinc
The role of tumor necrosis factor final.for puplicationShendy Sherif
Helicobacter pylori infection causes gastritis and peptic ulcers and is associated with increased levels of proinflammatory cytokines tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ). The study evaluated 148 patients with gastritis or peptic ulcers, finding high rates of positive IgG antibodies to H. pylori and its virulence factor CagA. Levels of TNF-α and IFN-γ were significantly higher in infected patients compared to controls, indicating their role in gastric inflammation caused by H. pylori. Estimating IgG levels and CagA positivity provides good immunodiagnostic markers for these diseases before endoscopy.
This document discusses the use of multiplex nucleic acid amplification tests (NAATs) to diagnose infectious diarrhea. It notes that traditional diagnostic methods have low sensitivity and long turnaround times. Multiplex NAATs allow simultaneous testing of stool for multiple pathogens, with higher sensitivity and shorter turnaround. However, they cannot provide antibiotic susceptibility or confirm identifications. The document reviews the pathogens detected by five FDA-approved multiplex NAAT platforms and notes their limitations, such as inability to distinguish carriers from infections or serotypes. It concludes that interpretation requires acknowledging limitations and clinical judgment, and more studies are needed on their cost-effectiveness and impact.
Development and validation of a novel diagnostic nomogram to differentiate be...Hidert Chusi Huamani
This study developed and validated two novel diagnostic nomograms to differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) using data from 310 patients across six hospitals in China. Eight variables were identified as valuable for establishing diagnostic models, including age, transverse ulcer, rectum involvement, skipped involvement of small bowel, target sign, comb sign, and interferon-gamma release assays or purified protein derivative test results. Two highly accurate nomograms were developed, with one showing 87.8% accuracy and the other showing 87.8% accuracy in differentiating CD from ITB. The nomograms provide a practical tool for clinicians to identify difficult cases of CD or ITB.
This document provides an overview of Helicobacter pylori infections. It discusses that H. pylori is the most common bacterial infection worldwide, affecting 70-90% of populations in developing countries. While most infections are asymptomatic, H. pylori can cause peptic ulcer disease in 10% of individuals and gastric cancer in 1%. The document outlines the microbiology of H. pylori, describing it as a gram-negative, microaerophilic spiral bacterium. It also discusses the pathogenesis of H. pylori infections and indications for testing. Treatment guidelines and various testing methods like invasive biopsy-based testing and non-invasive breath and stool antigen tests are also summarized.
This document reaffirms guidelines for diagnosing and managing urinary tract infections (UTIs) in infants and children ages 2-24 months. Key points include:
1) A urine specimen should be obtained through catheterization or suprapubic aspiration before starting antibiotics to accurately diagnose a UTI.
2) Clinical monitoring without testing is sufficient for febrile infants at low risk of UTI. For those at higher risk, urinalysis can guide need for culture.
3) Establishing a UTI diagnosis requires urinalysis showing infection and culture of ≥50,000 colony-forming units of a uropathogen from a properly obtained urine specimen.
4) Choice of antibiotic
This clinical practice guideline from the American Academy of Pediatrics provides recommendations for the diagnosis and management of initial urinary tract infections in febrile infants and young children aged 2 to 24 months. Key recommendations include:
1) If antimicrobial therapy is required urgently due to the infant's condition, a urine specimen must be obtained through catheterization or suprapubic aspiration before treatment to allow for accurate diagnosis of UTI.
2) For infants assessed as not requiring immediate treatment, clinicians should determine the likelihood of UTI based on specified risk factors. Low-risk infants require only clinical follow-up, while others should have urine tested or undergo ultrasound imaging of the kidneys and bladder.
3
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
1) A case-control study was conducted in Trinidad and Tobago to investigate a Salmonella outbreak occurring from 1988-1989. The study found that eating dishes containing raw or undercooked eggs was associated with Salmonella infection, with an almost 19 times higher risk among case patients.
2) Analysis of Salmonella isolates from 1988-1997 showed increases in S. Typhimurium and "Other" isolates initially, but S. Enteritidis became the dominant serotype starting in 1993. The highest infection rates were in children ages 0-4.
3) A seasonal pattern was observed, with peaks in Salmonella cases in May, December, and January each year from 1995-1997. This coinc
The role of tumor necrosis factor final.for puplicationShendy Sherif
Helicobacter pylori infection causes gastritis and peptic ulcers and is associated with increased levels of proinflammatory cytokines tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ). The study evaluated 148 patients with gastritis or peptic ulcers, finding high rates of positive IgG antibodies to H. pylori and its virulence factor CagA. Levels of TNF-α and IFN-γ were significantly higher in infected patients compared to controls, indicating their role in gastric inflammation caused by H. pylori. Estimating IgG levels and CagA positivity provides good immunodiagnostic markers for these diseases before endoscopy.
This study examined stool samples from 207 patients with diarrhea attending an HIV testing center in India, 115 of whom were HIV-infected. Intestinal parasites were found in 46.1% of HIV-infected patients compared to 17.4% of non-infected patients. The most common parasites identified among HIV-infected patients were Isospora belli (16.5%) and Cryptosporidium parvum (12.2%). Opportunistic protozoans were detected in 32.2% of HIV-infected patients but only 1.1% of non-infected patients, showing a significant association between opportunistic protozoan infection and HIV status. Higher rates of opportunistic protozoans
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
Positive Oral Contrast for Oncology Patients Naglaa Mahmoud
Routine use of positive oral contrast is not required for oncology patients undergoing follow-up CT scans according to a retrospective study. A survey found patients found oral contrast the least pleasant part of the scan. An audit of 447 patients found the bowel could be adequately identified in 90% without oral contrast and no cases required recall. On secondary review, the bowel could be identified in 95% without missed diseases, suggesting oral contrast is not necessary for accurate interpretation of follow-up oncology CT scans.
Helicobacter pylori is the most common chronic bacterial infection worldwide. It colonizes the stomach and can cause gastric and duodenal ulcers or increase the risk of stomach cancer. Treatment usually involves a combination of antibiotics and proton pump inhibitors over 10-14 days, with success rates around 70-90% depending on the regimen. Factors like antibiotic resistance in the region affect treatment outcomes. Eradication is important to prevent future complications and is confirmed after treatment via a urea breath test or stool antigen test.
Dr.NAGARJUNA JOURNAL - GUM CHEWING REDUCES POST OPERATIVE ILEUS?Butkuri Nagarjuna
This document summarizes a systematic review and meta-analysis on the effect of gum chewing in reducing postoperative ileus. The review included 9 randomized controlled trials with a total of 437 patients who underwent elective intestinal surgery. The meta-analysis found that gum chewing was associated with a shorter time to passing flatus (reduced by 14 hours) and stool (reduced by 23 hours), as well as a shorter hospital stay (reduced by 1.1 days). However, the evidence was limited by the small sample sizes of the included studies and lack of details on randomization and blinding methods. While gum chewing appears to be a low-cost intervention, more rigorous studies are still needed to confirm its benefits.
Two systematic reviews and meta-analyses found that chlorhexidine reduces postoperative wound infections compared to povidone-iodine when used as a preoperative skin antiseptic in clean-contaminated surgery. Noorani et al. (2010) found a risk ratio of 0.68 and Lee et al. (2010) found a risk ratio of 0.64. Culligan et al. (2005) also found that chlorhexidine reduced positive skin cultures compared to povidone-iodine after vaginal hysterectomy. The evidence indicates that for patients undergoing laparotomy, chlorhexidine is more effective than iodine at preventing postoperative wound infections when used as a preoperative antiseptic.
This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Helicobacter Pylori Infection: Management in 2020ChernHaoChong
1) Helicobacter pylori infection is common and testing should be done for patients with dyspepsia, peptic ulcer history, or family history of gastric cancer.
2) The urea breath test is the best tool to detect active H. pylori infection.
3) Patients who test positive for H. pylori antibodies should undergo a urea breath test to confirm active infection before treatment.
This document summarizes key technological innovations in gastrointestinal medicine, including high-resolution manometry and Bravo capsule pH monitoring. High-resolution manometry provides improved diagnosis of esophageal motility disorders over conventional manometry, with a diagnostic gain of 5-20%, and better characterization of achalasia subtypes. Bravo capsule pH monitoring provides a significant improvement over wired pH monitoring for gastroesophageal reflux diagnosis, with increased diagnostic yield due to less limited patient activity and longer recording periods up to 96 hours. Widespread adoption of these techniques is limited by their higher costs.
Les NVPO sont un événement fréquent en post-anesthésie puisqu'ils touchent environ un tiers des patients. Les différents scores et prophylaxies utilisées bien que souvent efficaces ne closent pas le chapitre de leur prévention. La gabapentine, antivonvusilvant, a montré par ailleurs son effet analgésique en post-opératoire.
Plus récemment, la gabapentine a montré un effet anti-émétique lorsqu'elle était administrée en prévention dans la chimiothérapie du cancer du sein.
Cette étude est une méta-analyse des essais randomisés de la gabapentine en prévention des NVPO. Elle conclut à son efficacité, efficacité d'autant plus marquée que le propofol n'est pas utilisé comme agent d'induction et/ou d'entretien.
This study analyzed urine samples from 1,670 patients in rural Odisha, India to determine the prevalence and etiology of community-acquired urinary tract infections (CA-UTIs). The key findings were:
1) The overall prevalence of CA-UTI was 34.5%, significantly higher in females (45.2%) than males (18.4%). Young women aged 18-37 and elderly men aged 68+ had the highest prevalence.
2) Escherichia coli was the most common causative organism (68.8%), followed by Enterococcus species. Gram-negative rods accounted for 78.2% of isolates.
3) Amikacin and nitrofurant
The FMD protocol has evolved over the past 20 years with several modifications proposed:
1. Removal of CHX from the original protocol, creating the full-mouth scaling approach (FMS).
2. Extension of hygiene methods and increasing the duration of post-treatment CHX use.
3. Replacement of CHX with other antiseptics like amine fluoride/stannous fluoride or povidone-iodine.
4. Supplementation with antibiotics like azithromycin or amoxicillin/metronidazole.
5. Addition of probiotics like Lactobacillus reuteri tablets.
Studies have found some modifications provide additional
Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.
Methods: A retrospective study was conducted at surgical pediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.
The guidelines provide new diagnostic criteria for coeliac disease (CD) based on recent scientific and technical developments. Two groups of patients are defined with different diagnostic approaches: 1) children with symptoms suggestive of CD and 2) asymptomatic children at increased risk.
For group 1, the diagnosis is based on symptoms, positive serology, and compatible histology. If anti-tissue transglutaminase antibody titers are >10 times the upper limit of normal, CD can be diagnosed without biopsies by applying further testing.
For group 2, the diagnosis is based on positive serology and histology. HLA testing for HLA-DQ2 and HLA-DQ8 is valuable to exclude CD if both haplotypes
Recent advances in diagnosis and treatment of tuberculosisAdeyemiKayode2
The document summarizes recent advances in the diagnosis and treatment of tuberculosis. It discusses how diagnosis has advanced from identifying the bacteria that causes TB to newer molecular diagnostic tests like Xpert MTB/RIF assay and whole genome sequencing that provide faster results. Treatment has advanced from historical non-antibiotic approaches to the current drug cocktail regimen, though drug resistance poses challenges. Advances in understanding drug mechanisms of action and detecting resistance mutations have also occurred.
This document summarizes 4 studies related to endoscopic treatments for GERD:
1. A randomized controlled trial is evaluating the Gatekeeper therapy which implants hydrogel prostheses in the LES to reduce GERD symptoms. Over 200 patients have been enrolled so far.
2. A study of endoscopic suturing for GERD found that while it improved symptoms in 50% of patients at 1 year, over 50% of the sutures had failed, indicating it may not be a reliable long-term alternative to medication.
3. A trial evaluated ablation of non-neoplastic Barrett's epithelium with argon plasma coagulation but found a high risk of complications and incomplete response
This document describes a study that evaluated cytological changes in exfoliated buccal mucosal cells from smokers compared to non-smokers using morphometric analysis. Buccal smears were collected from 120 individuals aged 40-60 years, with 90 in a smoker group and 30 in a non-smoker group. Nuclear area, cytoplasmic area, and nuclear-cytoplasmic ratio were measured in 50 cells per smear using image analysis software. Results found mean nuclear area was significantly higher in smokers, while mean cytoplasmic area was lower in smokers but not significantly. Nuclear-cytoplasmic ratio was also significantly higher in smokers. Heavier smoking exposure over more years showed more altered cytomorphometric values
JBry The Difference Between Physician Lit ReviewJessica Bryan
Three studies found that physicians were more likely than nurses to have pathogenic bacteria on their stethoscopes. Questionnaires in these studies revealed that most physicians did not clean their stethoscope after each use, unlike nurses who reported cleaning after each use. However, one study found no significant difference in contamination between physicians and nurses. Overall, stethoscopes were shown to be a vector for spreading bacteria like MRSA and E. coli from healthcare workers to immunocompromised patients. More emphasis on stethoscope disinfection education and practices is still needed.
“Efficacy and feasibility of Narrow Band Imaging Endoscopy for detection of H...SidneyPalha
1. This study aims to evaluate the use of Narrow Band Imaging endoscopy for the detection of Helicobacter pylori infection in patients presenting with dyspepsia.
2. 110 patients presenting with dyspepsia will undergo upper GI endoscopy with Narrow Band Imaging and have urease kit testing. Results will be analyzed to determine the sensitivity, specificity, and accuracy of NBI compared to the urease kit test.
3. The study hopes to identify the incidence of H. pylori infection in dyspepsia patients and analyze factors that influence detection using NBI endoscopy.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...daranisaha
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
This study examined stool samples from 207 patients with diarrhea attending an HIV testing center in India, 115 of whom were HIV-infected. Intestinal parasites were found in 46.1% of HIV-infected patients compared to 17.4% of non-infected patients. The most common parasites identified among HIV-infected patients were Isospora belli (16.5%) and Cryptosporidium parvum (12.2%). Opportunistic protozoans were detected in 32.2% of HIV-infected patients but only 1.1% of non-infected patients, showing a significant association between opportunistic protozoan infection and HIV status. Higher rates of opportunistic protozoans
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
Positive Oral Contrast for Oncology Patients Naglaa Mahmoud
Routine use of positive oral contrast is not required for oncology patients undergoing follow-up CT scans according to a retrospective study. A survey found patients found oral contrast the least pleasant part of the scan. An audit of 447 patients found the bowel could be adequately identified in 90% without oral contrast and no cases required recall. On secondary review, the bowel could be identified in 95% without missed diseases, suggesting oral contrast is not necessary for accurate interpretation of follow-up oncology CT scans.
Helicobacter pylori is the most common chronic bacterial infection worldwide. It colonizes the stomach and can cause gastric and duodenal ulcers or increase the risk of stomach cancer. Treatment usually involves a combination of antibiotics and proton pump inhibitors over 10-14 days, with success rates around 70-90% depending on the regimen. Factors like antibiotic resistance in the region affect treatment outcomes. Eradication is important to prevent future complications and is confirmed after treatment via a urea breath test or stool antigen test.
Dr.NAGARJUNA JOURNAL - GUM CHEWING REDUCES POST OPERATIVE ILEUS?Butkuri Nagarjuna
This document summarizes a systematic review and meta-analysis on the effect of gum chewing in reducing postoperative ileus. The review included 9 randomized controlled trials with a total of 437 patients who underwent elective intestinal surgery. The meta-analysis found that gum chewing was associated with a shorter time to passing flatus (reduced by 14 hours) and stool (reduced by 23 hours), as well as a shorter hospital stay (reduced by 1.1 days). However, the evidence was limited by the small sample sizes of the included studies and lack of details on randomization and blinding methods. While gum chewing appears to be a low-cost intervention, more rigorous studies are still needed to confirm its benefits.
Two systematic reviews and meta-analyses found that chlorhexidine reduces postoperative wound infections compared to povidone-iodine when used as a preoperative skin antiseptic in clean-contaminated surgery. Noorani et al. (2010) found a risk ratio of 0.68 and Lee et al. (2010) found a risk ratio of 0.64. Culligan et al. (2005) also found that chlorhexidine reduced positive skin cultures compared to povidone-iodine after vaginal hysterectomy. The evidence indicates that for patients undergoing laparotomy, chlorhexidine is more effective than iodine at preventing postoperative wound infections when used as a preoperative antiseptic.
This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Helicobacter Pylori Infection: Management in 2020ChernHaoChong
1) Helicobacter pylori infection is common and testing should be done for patients with dyspepsia, peptic ulcer history, or family history of gastric cancer.
2) The urea breath test is the best tool to detect active H. pylori infection.
3) Patients who test positive for H. pylori antibodies should undergo a urea breath test to confirm active infection before treatment.
This document summarizes key technological innovations in gastrointestinal medicine, including high-resolution manometry and Bravo capsule pH monitoring. High-resolution manometry provides improved diagnosis of esophageal motility disorders over conventional manometry, with a diagnostic gain of 5-20%, and better characterization of achalasia subtypes. Bravo capsule pH monitoring provides a significant improvement over wired pH monitoring for gastroesophageal reflux diagnosis, with increased diagnostic yield due to less limited patient activity and longer recording periods up to 96 hours. Widespread adoption of these techniques is limited by their higher costs.
Les NVPO sont un événement fréquent en post-anesthésie puisqu'ils touchent environ un tiers des patients. Les différents scores et prophylaxies utilisées bien que souvent efficaces ne closent pas le chapitre de leur prévention. La gabapentine, antivonvusilvant, a montré par ailleurs son effet analgésique en post-opératoire.
Plus récemment, la gabapentine a montré un effet anti-émétique lorsqu'elle était administrée en prévention dans la chimiothérapie du cancer du sein.
Cette étude est une méta-analyse des essais randomisés de la gabapentine en prévention des NVPO. Elle conclut à son efficacité, efficacité d'autant plus marquée que le propofol n'est pas utilisé comme agent d'induction et/ou d'entretien.
This study analyzed urine samples from 1,670 patients in rural Odisha, India to determine the prevalence and etiology of community-acquired urinary tract infections (CA-UTIs). The key findings were:
1) The overall prevalence of CA-UTI was 34.5%, significantly higher in females (45.2%) than males (18.4%). Young women aged 18-37 and elderly men aged 68+ had the highest prevalence.
2) Escherichia coli was the most common causative organism (68.8%), followed by Enterococcus species. Gram-negative rods accounted for 78.2% of isolates.
3) Amikacin and nitrofurant
The FMD protocol has evolved over the past 20 years with several modifications proposed:
1. Removal of CHX from the original protocol, creating the full-mouth scaling approach (FMS).
2. Extension of hygiene methods and increasing the duration of post-treatment CHX use.
3. Replacement of CHX with other antiseptics like amine fluoride/stannous fluoride or povidone-iodine.
4. Supplementation with antibiotics like azithromycin or amoxicillin/metronidazole.
5. Addition of probiotics like Lactobacillus reuteri tablets.
Studies have found some modifications provide additional
Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.
Methods: A retrospective study was conducted at surgical pediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.
The guidelines provide new diagnostic criteria for coeliac disease (CD) based on recent scientific and technical developments. Two groups of patients are defined with different diagnostic approaches: 1) children with symptoms suggestive of CD and 2) asymptomatic children at increased risk.
For group 1, the diagnosis is based on symptoms, positive serology, and compatible histology. If anti-tissue transglutaminase antibody titers are >10 times the upper limit of normal, CD can be diagnosed without biopsies by applying further testing.
For group 2, the diagnosis is based on positive serology and histology. HLA testing for HLA-DQ2 and HLA-DQ8 is valuable to exclude CD if both haplotypes
Recent advances in diagnosis and treatment of tuberculosisAdeyemiKayode2
The document summarizes recent advances in the diagnosis and treatment of tuberculosis. It discusses how diagnosis has advanced from identifying the bacteria that causes TB to newer molecular diagnostic tests like Xpert MTB/RIF assay and whole genome sequencing that provide faster results. Treatment has advanced from historical non-antibiotic approaches to the current drug cocktail regimen, though drug resistance poses challenges. Advances in understanding drug mechanisms of action and detecting resistance mutations have also occurred.
This document summarizes 4 studies related to endoscopic treatments for GERD:
1. A randomized controlled trial is evaluating the Gatekeeper therapy which implants hydrogel prostheses in the LES to reduce GERD symptoms. Over 200 patients have been enrolled so far.
2. A study of endoscopic suturing for GERD found that while it improved symptoms in 50% of patients at 1 year, over 50% of the sutures had failed, indicating it may not be a reliable long-term alternative to medication.
3. A trial evaluated ablation of non-neoplastic Barrett's epithelium with argon plasma coagulation but found a high risk of complications and incomplete response
This document describes a study that evaluated cytological changes in exfoliated buccal mucosal cells from smokers compared to non-smokers using morphometric analysis. Buccal smears were collected from 120 individuals aged 40-60 years, with 90 in a smoker group and 30 in a non-smoker group. Nuclear area, cytoplasmic area, and nuclear-cytoplasmic ratio were measured in 50 cells per smear using image analysis software. Results found mean nuclear area was significantly higher in smokers, while mean cytoplasmic area was lower in smokers but not significantly. Nuclear-cytoplasmic ratio was also significantly higher in smokers. Heavier smoking exposure over more years showed more altered cytomorphometric values
JBry The Difference Between Physician Lit ReviewJessica Bryan
Three studies found that physicians were more likely than nurses to have pathogenic bacteria on their stethoscopes. Questionnaires in these studies revealed that most physicians did not clean their stethoscope after each use, unlike nurses who reported cleaning after each use. However, one study found no significant difference in contamination between physicians and nurses. Overall, stethoscopes were shown to be a vector for spreading bacteria like MRSA and E. coli from healthcare workers to immunocompromised patients. More emphasis on stethoscope disinfection education and practices is still needed.
“Efficacy and feasibility of Narrow Band Imaging Endoscopy for detection of H...SidneyPalha
1. This study aims to evaluate the use of Narrow Band Imaging endoscopy for the detection of Helicobacter pylori infection in patients presenting with dyspepsia.
2. 110 patients presenting with dyspepsia will undergo upper GI endoscopy with Narrow Band Imaging and have urease kit testing. Results will be analyzed to determine the sensitivity, specificity, and accuracy of NBI compared to the urease kit test.
3. The study hopes to identify the incidence of H. pylori infection in dyspepsia patients and analyze factors that influence detection using NBI endoscopy.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...daranisaha
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...JohnJulie1
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...semualkaira
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...semualkaira
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
The document discusses the history and discovery of Helicobacter pylori and its role in peptic ulcer disease. It describes how in the 1980s, Drs. Barry Marshall and Robin Warren discovered that H. pylori infection was a major cause of peptic ulcers, overturning decades of belief. Their discovery was initially met with resistance from the medical community but was later recognized with the 2005 Nobel Prize in Physiology or Medicine. The document also discusses the epidemiology, diagnosis, treatment and antibiotic resistance of H. pylori infection.
Helicobacter pylori infection is associated with increased risk of gastric cancer development. A prospective study of 1526 Japanese patients found:
1) Gastric cancer developed in 36 (2.9%) of infected patients but none of 280 uninfected patients over 7.8 years of follow up.
2) Infected patients with severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia were at highest risk.
3) Gastric cancer risk was highest in infected patients with nonulcer dyspepsia (4.7%), gastric ulcers (3.4%), or gastric polyps (2.2%) but none in those with duodenal ulcers.
Helicobacter pylori is a bacteria that causes peptic ulcers and is linked to gastric cancer. There are invasive and non-invasive tests to diagnose H. pylori infection. Invasive tests include histology, culture, and rapid urease test, while non-invasive options are urea breath test, stool antigen test, and serology. Molecular techniques like PCR are also used and can identify specific genes or antibiotic resistance. The accuracy of diagnostic tests may be affected in cases of bleeding or partial gastrectomy. Post-treatment tests like urea breath test are recommended to confirm eradication success.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
pancrease & glucose homeostasisNew microsoft office power point presentationManoj Mishra
This document summarizes a study on the prevalence of Helicobacter pylori infection in patients with peptic ulcer disease in Manipur, India. The study found a prevalence of H. pylori infection of 20% among 60 peptic ulcer patients, which is significantly lower than other studies in India. Positive H. pylori status was significantly associated with non-vegetarian diet and not taking anti-ulcer drugs in the past week. The study concludes that a rapid antibody test kit is a suitable, cheap, and reliable screening technique for H. pylori infection in peptic ulcer patients.
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
This document summarizes the key outcomes and recommendations from the Maastricht V/Florence Consensus Report on the management of Helicobacter pylori infection. It discusses the methodology used, including a Delphi consensus process and expert working groups. Several consensus statements are provided on indications for testing and treating H. pylori infection, the role of endoscopy, the impact of H. pylori on acid secretion, its association with dyspeptic symptoms, and the need to exclude H. pylori infection for a diagnosis of functional dyspepsia. The document emphasizes that H. pylori gastritis is an infectious disease irrespective of symptoms, and that curing the infection can provide long-
This article discusses Helicobacter pylori infection, which causes chronic inflammation in the stomach. H. pylori infection is linked to gastric and duodenal ulcers, gastric cancer, and gastric MALT lymphoma. The article reviews evidence on testing and treating H. pylori infection, guidelines for appropriate testing candidates, and strategies for uninvestigated dyspepsia. Treatment of H. pylori infection cures most ulcers and reduces cancer risk, but has limited benefit for functional dyspepsia in the absence of ulcers.
Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoeaUtai Sukviwatsirikul
This systematic review and meta-analysis evaluated the effectiveness of Saccharomyces boulardii in preventing antibiotic-associated diarrhea in children and adults based on 21 randomized controlled trials involving 4780 participants. The administration of S. boulardii compared to placebo or no treatment reduced the risk of antibiotic-associated diarrhea from 18.7% to 8.5%. S. boulardii was effective in reducing the risk of antibiotic-associated diarrhea in both children and adults. It also reduced the risk of Clostridium difficile-associated diarrhea in children but not adults. Overall, the results confirm that S. boulardii is effective for preventing antibiotic-associated diarrhea in children and adults.
Systematic review with meta-analysis: Saccharomyces boulardii in the preventi...Utai Sukviwatsirikul
This systematic review and meta-analysis evaluated the effectiveness of Saccharomyces boulardii in preventing antibiotic-associated diarrhea in children and adults based on 21 randomized controlled trials involving 4780 participants. The administration of S. boulardii compared to placebo or no treatment reduced the risk of antibiotic-associated diarrhea from 18.7% to 8.5%. S. boulardii was effective in reducing the risk of antibiotic-associated diarrhea in both children and adults. It also reduced the risk of Clostridium difficile-associated diarrhea in children. The quality of evidence was rated as moderate to low based on limitations in the design and reporting of the included studies. This meta-analysis confirms the effectiveness of
Helicobacter pylori associated Peptic ulcer diseaseS M Ali Hasan
Helicobacter pylori is a common cause of peptic ulcer disease. It infects about half of the global population and transmission occurs through person-to-person contact or from infected instruments. Only 10-15% of infected individuals develop ulcers or other diseases. In Bangladesh, H. pylori infection rates are very high, ranging from 67-92% in studies. Treatment involves antibiotic regimens but resistance is a problem, with high rates of resistance to clarithromycin, metronidazole, and levofloxacin seen in Bangladesh. Management of peptic ulcers involves testing and treating H. pylori, endoscopic treatment for bleeding ulcers, and maintenance therapy to prevent
Cor pulmonale, also known as pulmonary heart disease, is a type of heart disease where the right side of the heart enlarges and fails over time due to high blood pressure in the lungs or pulmonary hypertension. It is usually caused by lung diseases like chronic obstructive pulmonary disease (COPD) that result in low oxygen levels and resistance within the pulmonary arteries of the lungs. The enlarged right ventricle must work harder to pump blood into the lungs, causing it to thicken and eventually fail if left untreated.
Peptic ulcers develop in the lining of the stomach or small intestine. Common causes are infection by H. pylori bacteria and use of pain medications like ibuprofen. Symptoms include stomach pain that is worse when the stomach is empty. Diagnosis involves tests to detect H. pylori infection and endoscopy to view the digestive tract. Treatment eliminates the bacteria with antibiotics if present, reduces acid production, and promotes healing with proton pump inhibitors or acid blockers. Preventive measures include careful use of pain medications and protecting against infections.
Pancreatitis is inflammation of the pancreas that can be acute or chronic. It occurs when digestive enzymes in the pancreas are activated and damage pancreatic cells. Common causes include alcoholism, gallstones, certain medications, abdominal injuries, and genetic factors. Symptoms vary but often include abdominal pain that worsens with eating as well as nausea and vomiting. Diagnosis involves blood tests, imaging scans, and endoscopy. Treatment focuses on relieving symptoms, treating underlying causes, and managing complications. To prevent pancreatitis, avoiding excessive alcohol consumption and following a low-fat diet can help reduce risk.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder defined by abdominal pain and changes in bowel habits. The causes are unclear but may involve stress, infection, or brain-gut interactions. Symptoms include abdominal pain, gas, bloating, and diarrhea or constipation. Diagnosis is based on symptoms, and tests rule out other conditions. Treatment focuses on lifestyle changes like diet, exercise, and stress relief. Medications may help control symptoms but no single treatment works for everyone with this common disorder.
Inflammatory bowel disease (IBD) describes disorders that involve chronic inflammation of the digestive tract, including ulcerative colitis and Crohn's disease. The exact cause is unknown but is likely related to malfunctions of the immune system. Symptoms vary in severity from mild to severe and include diarrhea, abdominal pain, bleeding, and weight loss. Diagnosis involves blood tests, endoscopy, imaging, and ruling out other potential causes. Treatment aims to reduce inflammation and includes anti-inflammatory drugs, immunosuppressants, antibiotics, and surgery in some cases.
Helicobacter pylori is a type of bacteria that infects the stomach and is the most common cause of gastritis and peptic ulcers worldwide. Infection is very common and increases with age. H. pylori bacteria can be transmitted through direct contact with infected feces or vomit, or through contaminated food or water. While most infected people never show symptoms, potential symptoms include abdominal pain, nausea, loss of appetite, and weight loss. Diagnosis involves tests of the blood, breath, or stool to detect H. pylori. Treatment consists of antibiotics along with medication to reduce stomach acid in order to kill the bacteria and allow the stomach lining to heal.
Gastroesophageal reflux disease (GERD) occurs when stomach acid returns up into the esophagus and causes irritation. It is common for people to experience acid reflux occasionally, but GERD is when it occurs at least twice a week or more severely once a week. Risk factors include obesity, pregnancy, smoking, and certain medications. Symptoms include heartburn, nausea, coughing, and sore throat. Diagnosis is usually based on symptoms, but tests like endoscopy or pH monitoring can be done. Treatment involves lifestyle changes like losing weight, avoiding foods and drinks that trigger symptoms, and medications to reduce acid production. Surgery may be an option for severe cases that do not improve with other treatments.
Gastroenteritis is inflammation of the stomach and intestines that is usually caused by viruses, bacteria, or parasites. Common symptoms include diarrhea, nausea, vomiting, and abdominal pain. While generally self-limiting, gastroenteritis can cause dehydration, which is more common and dangerous in infants and young children. Oral rehydration solutions are the recommended treatment for mild to moderate dehydration. Prevention involves proper food handling and drinking clean water, especially when traveling.
1. Gastrointestinal stromal tumors (GIST) are rare tumors that can develop in the wall of the gastrointestinal tract and can be cancerous (malignant) or non-cancerous (benign). Risk factors include inherited genetic mutations and rare genetic syndromes.
2. Symptoms of GIST tumors include blood in stool or vomit, abdominal pain, fatigue, difficulty swallowing, and feeling full after eating small amounts of food. Diagnosis involves physical exams, CT scans, MRI scans, endoscopic ultrasounds, and biopsies of suspicious tissue.
3. Treatment depends on the stage and location of the tumor and may involve surgical resection as the only potentially curative treatment
1. Gastritis is inflammation of the lining of the stomach that is usually caused by Helicobacter pylori infection or excessive alcohol or drug use. It can be acute or chronic.
2. Common causes include H. pylori infection, NSAIDs, alcohol, bile reflux, autoimmune disorders, and stress. Symptoms may include abdominal pain, nausea, vomiting, and black stools from bleeding.
3. Diagnosis involves blood tests, endoscopy, and stool tests. Treatment focuses on eliminating the cause, using antacids or other drugs to reduce stomach acid, and antibiotics to treat H. pylori infection. Preventing overuse of NSAIDs and limiting alcohol and sp
1. Esophageal motor disorders are alterations in the peristaltic activity of the esophageal body and/or functioning of the sphincters. There are primary motor disorders that affect the esophageal body and lower esophageal sphincter including achalasia, diffuse esophageal spasm, and hypercontractile disorders.
2. The etiology of spastic motor disorders is divided into primary and secondary causes. The primary causes include diffuse esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter. The pathophysiology involves alterations in nitric oxide synthesis and degradation affecting normal peristalsis.
3. Symptoms include chest pain, dysphagia
Dyspepsia, also known as indigestion, refers to discomfort or pain in the upper abdomen that is often caused by eating. Common symptoms include pain, swelling, heartburn, and nausea. While the specific cause is unknown in most cases, potential causes include stress, medications like aspirin, Helicobacter pylori bacteria, smoking, alcohol, spicy or greasy foods, and large meal sizes. Diagnosis involves tests like abdominal ultrasounds and endoscopies of the esophagus, stomach, and duodenum. Treatment focuses on diet changes, antibiotics to eliminate H. pylori if present, and medications to reduce acid like omeprazole. Prevention includes relaxing after
This document discusses diseases of the rectum and anus. It begins with definitions and explains that these diseases are commonly seen in primary care. It describes some of the main diseases including their causes, symptoms, and risk factors. Some of the diseases covered include hemorrhoids, anal fissures, abscesses, and anal cancer. The document discusses how these diseases are diagnosed, often through examination with an anoscope or sigmoidoscope. It also outlines treatments for some conditions like surgery, radiation therapy, and chemotherapy for anal cancer. Lastly, it discusses some ways to prevent diseases like avoiding risk factors, screening high risk patients, and vaccinations to prevent HPV infections.
The document discusses diseases of the mouth cavity. It defines the mouth and its functions, and describes common mouth problems like cold sores, canker sores, and infections. Diagnosis involves examination by a dentist, and treatment depends on the specific problem but may include cleaning, surgery, or maintenance visits. Prevention strategies include avoiding tobacco and excessive alcohol, eating fruits and vegetables, protecting lips from sun, and regular dental exams.
The document discusses digestive hemorrhage, also known as gastrointestinal bleeding. It defines high and low hemorrhages based on their origin in the digestive tract. Some common causes of digestive hemorrhage include anal fissures, hemorrhoids, ulcers, and cancers of the digestive system. Symptoms include vomiting blood or black tarry stools. Diagnosis involves endoscopy, imaging tests, or surgery depending on the location of bleeding. Treatment focuses on stabilization, determining the cause through endoscopy, and addressing the specific condition causing the hemorrhage. Prevention strategies target those with risk factors like ulcers, cirrhosis, or who take anti-inflammatory drugs.
1. Diarrhea is defined as more frequent bowel movements with soft and liquid stools. It is usually caused by viruses, bacteria, parasites, certain foods, medications, and other digestive disorders.
2. Symptoms of diarrhea include soft, watery stools, abdominal cramps, pain, fever, blood in stool, swelling, and urgency. It can cause dehydration, especially in children.
3. Doctors may perform blood tests, stool analysis, and imaging tests to diagnose the cause. Treatment depends on the cause but often involves replacing fluids and electrolytes, antibiotics if bacteria is involved, and managing any underlying conditions.
Constipation is defined as having less than three bowel movements per week or hard stools that are difficult to pass. Common causes include low-fiber diets, lack of physical activity, certain medications, and ignoring the urge to have a bowel movement. Diagnosis involves physical exams, blood tests, and imaging tests of the colon and rectum. Treatment begins with lifestyle changes like increasing fiber intake and exercise. If those don't help, doctors may prescribe laxatives, stool softeners, or suppositories to relieve constipation symptoms.
Sleep apnea is a potentially serious sleep disorder where breathing stops and starts repeatedly during sleep. There are three main types - obstructive, central, and complex. Risk factors include being overweight, having a narrow throat, and certain facial structures. Symptoms include loud snoring, waking with shortness of breath, and daytime sleepiness. Diagnosis involves a physical exam and polysomnogram sleep test. Treatment options include lifestyle changes, CPAP devices, dental devices, and sometimes surgery. Losing weight and avoiding alcohol can help prevent sleep apnea.
1. Pulmonary tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis, which usually affects the lungs. It spreads through the air when people who are sick with TB cough, sneeze or speak.
2. Symptoms include a persistent cough lasting more than two weeks, coughing up blood, weight loss, fever, night sweats and fatigue. Diagnosis involves physical exams, chest x-rays, sputum tests and tuberculosis skin tests.
3. Treatment involves a multi-drug regimen administered by a tuberculosis specialist to prevent drug resistance. Patients are advised to rest at home and cover their mouth when coughing to prevent spreading the disease until treatment has reduced their contagious
1. Pulmonary embolism is caused by a blood clot in the lung, usually formed in the deep veins of the lower limbs. It is a leading cause of preventable death in hospitalized patients.
2. Symptoms include shortness of breath, chest pain, increased heart rate, coughing up blood, and fainting. Diagnosis involves assessing risk factors and test like D-dimer and CT scan.
3. Treatment involves anticoagulant drugs to dissolve clots initially by injection and then orally for 3-6 months. Prevention focuses on continuing anticoagulants, lifestyle changes like exercise and diet, wearing compression stockings, and early movement after surgery.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. INTRODUCTION
A reliable primary diagnosis and control of treatment
success of Helicobacter pylori (H. pylori) infection is crucial
for patients with a wide spectrum of H. pylori-related
conditions, including uncomplicated or complicated ulcer
disease, mucosa associated lymphoid tissue (MALT) lym-
phoma, atrophic gastritis and previous partial gastric re-
section for gastric cancer. Accurate diagnosis of H. pylori
infection involves the combined knowledge, effort and
research of laboratories, gastroenterologists and patholo-
gists. Traditional diagnosis is made using a combination
of tests, both invasive and noninvasive. Considering the
broad spectrum of diagnostic methods, only highly accu-
rate tests should be used in clinical practice under specific
circumstances and currently, the sensitivity and specific-
ity of such tests should exceed 90%. The choice of tests
usually depends on clinical circumstances, the likelihood
ratio of positive and negative tests, the cost-effectiveness
of the testing strategy and of the availability of the tests.
The present paper aimed to present an overview of the
most recent advances in both biopsy- and non-biopsy-
based diagnostic methods for H. pylori infection (Table 1).
ENDOSCOPY
Considering that accurate prediction of H. pylori infection
status on endoscopic images can improve early detection
of gastric cancer, especially in some geographic areas, the
contribution of both conventional and novel endoscopic
evaluation methodologies has received increased atten-
tion, particularly in specific clinical settings. A summary
of the latest endoscopic studies is presented below. Wata-
nabe et al[1]
studied the diagnostic yield of endoscopy
for H. pylori infection at three endoscopist career levels
- beginner, intermediate and advanced. For this study,
77 consecutive patients who underwent endoscopy were
analyzed for H. pylori infection status by histology, serol-
ogy and urea breath test (UBT). The diagnostic yield was
88.9% for H. pylori-uninfected, 62.1% for H. pylori-in-
fected, and 55.8% for H. pylori-eradicated. Intra-observer
agreement for H. pylori infection status was good (k >
0.6) for all physicians, while inter-observer agreement
was lower (k = 0.46) for beginners than for intermediate
and advanced (k > 0.6). For all physicians, good inter-
observer agreement in endoscopic findings was seen for
atrophic change (k = 0.69), but the accuracy was lower
for beginners.
In 496 asymptomatic Japanese middle-aged men, a
prospective evaluation (mean follow-up period of 54
years), of gastric cancer development was performed in
non-atrophic stomachs with highly active inflammation
identified by serum levels of pepsinogen and H. pylori
antibody, together with a specific endoscopic feature:
endoscopic rugal hyperplastic gastritis (RHG) (reflecting
localized highly active inflammation)[2]
. Cancer incidence
was significantly higher in patients with RHG, high H.
pylori antibody titers and low PG Ⅰ/Ⅱ ratio than in pa-
tients without. Significantly, no cancer development was
observed in these high-risk subjects after H. pylori eradi-
cation. This study emphasizes the high risk of cancer
development in subjects with H. pylori-associated highly
active non-atrophic gastritis and the utility of the two
serological tests and endoscopic RHG for their identifica-
tion.
Considering that H. pylori eradication is essential for
metachronous gastric cancer prevention in patients un-
dergoing endoscopic mucosectomy (EMR) for early gas-
tric cancer, as reported by Fukase et al[3]
, Lee et al[4]
aimed
to determine the optimal biopsy site for H. pylori detec-
tion in the atrophic remnant mucosa of 91 EMR patients.
Three paired biopsies for histology were taken at the
antrum, corpus lesser (CLC), and greater curve (CGC).
Additional specimens were obtained at the antrum and
CGC for a rapid urease test (RUT). H. pylori infection was
defined as at least two positive specimens on histology
and/or RUT. Pepsinogen levels were used to determine
serological atrophy. The authors concluded that CGC
is the optimal biopsy site for H. pylori diagnosis in EMR
patients with extensive atrophy and that an antral biopsy
should be avoided, especially in serologically atrophic pa-
tients.
Although gastroscopic biopsy-based tests such as the
RUT, histological examination, and culture have been
widely used to diagnose H. pylori infection, many investi-
gators have attempted to categorize the endoscopic find-
ings characteristic of an H. pylori-infected stomach.
In 2002, Japanese endoscopists[5]
found that collecting
venules, seen as numerous minute red dots in the gastric
corpus, were a characteristic finding in the normal stom-
ach without H. pylori infection, using both standard and
magnifying endoscopy (identification of micro mucosal
patterns). This finding was termed “regular arrangement
of collecting venules” (RAC). However, these findings
are not a reliable method of diagnosis because of their
low sensitivity and specificity.
Although magnifying endoscopy provides more
precise information concerning abnormal mucosal pat-
terns[6,7]
, it is not available in all endoscopy units. More-
over, its use requires training under an experienced super-
visor and expertise. In addition, magnifying endoscopy
is not necessarily appropriate for routine clinical practice
because it is time-consuming and only a few facilities
carry out this technique on a routine basis. On the other
hand, endoscopic features corresponding to Sydney Sys-
Lopes AI et al. H. pylori diagnosis advances
9300 July 28, 2014|Volume 20|Issue 28|WJG|www.wjgnet.com
Table 1 Summary of diagnostic methods
Invasive/
noninvasive
Reference
method
Antibiotic resistance
detection
Endoscopy Invasive Yes No
Histology Invasive Yes No
Rapid urease test Invasive No No
Culture Invasive Yes Yes
Molecular methods Both No Yes
Serology Noninvasive No No
Urea breath test Noninvasive No No
Stool antigen test Noninvasive No No
3. tem pathological findings have not yet been identified,
and the diagnosis of H. pylori infection in the gastric mu-
cosa by endoscopic features has not yet been established
(Figure 1). In this setting, the Study Group of Japan
Gastroenterological Endoscopy Society for Establishing
Endoscopic Diagnosis of Chronic Gastritis performed
a prospective multicenter study enrolling 275 patients[8]
,
investigating the association between endoscopic findings
(conventional findings and indigo carmine contrast) and
histological diagnosis of H. pylori (antrum and corpus).
It was shown that specific endoscopic findings, such as
diffuse redness, spotty redness and mucosal swelling as-
sessed by conventional endoscopy and swelling of areae
gastricae by the indigo carmine contrast method, were use-
ful for diagnosing H. pylori infection.
Cho et al[9]
aimed to establish a new classification for
predicting H. pylori-infected stomachs by non-magnifying
standard endoscopy alone. A total of 617 participants
who underwent gastroscopy were enrolled prospectively
and a careful close-up examination of the corpus at the
greater curvature was performed, maintaining a distance
of 10 mm between the endoscope tip and the mucosal
surface. Despite being a monocenter study in which
standard endoscopy was not directly compared with mag-
nifying endoscopy, these results suggest two important
contributions for prediction of H. pylori infection status:
(1) the observation of gastric mucosal patterns using
standard endoscopy and proposal of a new endoscopic
classification including a normal RAC and three abnor-
mal mucosal patterns; and (2) an accuracy of prediction
of H. pylori positivity at least similar to that reported in
magnifying endoscopy studies (sensitivity of 95.2% and
specificity of 82.2%)[10]
. In the future, multicenter trials
comparing standard endoscopy against magnifying en-
doscopy, including changes in mucosal patterns after H.
pylori eradication, and including endoscopists with differ-
ent levels of expertise, are needed to confirm the reliabil-
ity of these data.
Chromoendoscopy has also regained attention re-
cently as an additional methodology to detect H. pylori in
the gastric mucosa. A multicenter Japanese study involv-
ing 275 patients evaluated the possibility of diagnosing
H. pylori by conventional endoscopy and chromoendos-
copy using indigo carmine compared with histology
performed according to the Sydney System[7]
. Based on
several indices, the authors obtained a sensitivity of 94%
in the corpus and 88% in the antrum. However, the spec-
ificities in the corpus and in the antrum were low (62%
and 52%, respectively). Another study using a Cuban
adult population[11]
also aimed to evaluate the diagnostic
yield of chromoendoscopy with red phenol at 0.1% for
the detection of H. pylori infection against histology. This
study reported a sensitivity of 72.6% (95%CI: 64.9-79.2)
and a specificity of 75.5% (95%CI: 61.9-85.4). The au-
thors concluded that it might be a useful method to diag-
nose H. pylori infection in the gastric mucosa, potentially
with some specific advantages (topographic localization,
avoidance of contamination and fast and immediate read-
ing).
HISTOLOGY
Although histology has been considered to be the gold
standard for H. pylori detection, the influence of clinical
practice on the histopathological detection of H. pylori in-
fection has been insufficiently explored. Recognizing that
the number and distribution of H. pylori organisms vary
in patients taking proton pump inhibitors (PPIs), it has
been recommended to discontinue PPIs two weeks be-
fore endoscopy and to take biopsies from both the body
and the antrum.
In a representative study, Lash et al[12]
aimed to evalu-
ate the yield of different gastric sampling strategies and
to determine the adherence to the Sydney System guide-
lines in a nationwide sample of endoscopists in United
States. Using a database of biopsy records diagnosed at a
single pathology laboratory, the results of gastric biopsies
taken to evaluate gastric inflammatory conditions in pa-
tients with no endoscopic lesions were reviewed. The in-
cisura angularis, rarely sampled, yielded minimal additional
diagnostic information and the acquisition of at least
two biopsy specimens from the antrum and corpus, es-
sentially following the Sydney System recommendations,
was confirmed as a sensible strategy that guarantees the
maximum diagnostic yield for the most common gastric
inflammatory conditions.
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Figure 1 Endoscopic features of Helicobacter pylori infection (antral nodularity).
BA
Lopes AI et al. H. pylori diagnosis advances
4. for H. pylori, with the lowest rate of inter observer varia-
tion and is much faster than conventional histology[19]
.
However, the necessity for routine special stains and/or
IHC stains has been debated in recent years. A recent
study by Wang et al[20]
confirmed what many pathologists
assume: routine special stains, specifically IHC stains, are
not cost-effective or necessary. Recently, Smith et al[21]
, in
a retrospective study involving 200 consecutive gastric
biopsy specimens, further confirmed that H. pylori is eas-
ily observed in the majority of cases with HE (sensitivity
91% and specificity 100%), remaining the most expedient
and least expensive test for identifying H. pylori in gastric
biopsies.
An institutional quality assurance study of a conven-
tional method for the diagnosis of H. pylori - associated
gastritis was performed by Hartman et al[22]
in the United
States, based on head-to-head evaluation by four meth-
ods, HE stain, Giemsa stain, Warthin-Starry stain, and H.
pylori immunostaining of 356 gastric biopsy specimens.
About 83% of H. pylori gastritis identified were diag-
nosed on the initial HE-stained slides, further supporting
the use of routine ancillary stains to diagnose H. pylori
infection in gastric biopsy specimens. Usually, the use of
special stains is only recommended for biopsy specimens
with moderate to severe chronic active or inactive gastri-
tis in which H. pylori is not identified by HE staining, for
post-treatment biopsy specimens and in cases in which
structures “suspicious”, but not definitive, for H. pylori
are observed by HE staining[23]
.
Both routine conventional histology-based methods
and novel methods for H. pylori detection have increas-
ingly focused on specific clinical settings and patient
groups (bleeding peptic ulcer, gastric cancer). False-
negative results may occur when using histological and
RUT to detect H. pylori in biopsy specimens obtained
during peptic ulcer bleeding episodes (PUB). Choi et al[24]
evaluated different diagnostic methods in the specific
setting of peptic ulcer, concluding that histology was the
most accurate test, regardless of bleeding, compared with
culture, serology and RUT. Ramirez-Lazaro et al[25]
found
that IHC and real-time PCR methods might improve the
sensitivity of biopsy-based diagnosis in this specific set-
ting (PUB).
In patients submitted to a subtotal gastrectomy due
to gastric cancer, the identification and treatment of
H. pylori are the key points in the prevention of cancer
recurrence. Xu et al[26]
evaluated the predictive value of
neutrophil infiltration, a hallmark of active inflammation
(updated Sydney system), as a histological marker of H.
pylori infection, in 315 dyspeptic patients undergoing up-
per gastrointestinal endoscopy, including patients with a
subtotal gastrectomy. The diagnosis of H. pylori infection
was based on UBT and on anti-H. pylori immunoglobulin
G (IgG) antibody in patient with a subtotal gastrectomy.
Although neutrophil infiltration of gastric mucosa was
strongly associated with overall H. pylori infection, in pa-
tients with a subtotal gastrectomy, the diagnostic accuracy
of neutrophil infiltration in H. pylori infection was low.
In a Canadian study[13]
, electronic patient records were
evaluated for the sites of gastric sampling and PPI use at
endoscopy, collecting 150 cases with biopsies taken from
both the antrum and body, which were randomly selected
for pathological re-review with special stains. The gastric
regions sampled, H. pylori distribution and influence of
clinical factors on pathological interpretation were as-
sessed. This study confirmed that, despite national and
international guidelines for managing H. pylori infection,
these guidelines are infrequently adhered to, with PPIs
frequently contributing to false diagnosis, and sampling
only one region increases the likelihood of missing active
infection by at least 15%.
Considering that atrophy of the stomach mucosa
develops in about 50% of H. pylori infected individuals
by the age of 65, and is considered a pre-malignant le-
sion for gastric cancer[14-16]
, H. pylori eradication is recom-
mended in the presence of atrophy[17]
, because atrophy
may reverse after successful eradication therapy. It is
critically important and challenging, therefore, to deter-
mine the presence or absence of H. pylori in patients with
atrophic gastritis. During atrophy progression, however,
the density of H. pylori in the stomach mucosa decreases,
and may disappear completely during the late stages of
atrophy[14,16]
. This may explain the markedly lower sen-
sitivity of biopsy-based tests (RUT, histology, culture)
in the presence of atrophy. Similarly, UBT and antigen
stool detection can also give false-negative results in these
circumstances. In contrast, serology is not influenced to
such an extent by a lower density of the microorganism,
and is reliable even in advanced gastric body atrophy[14,16]
.
Maastricht guidelines updates have reserved serology
for special situations, including extensive atrophy of the
stomach mucosa on the basis that other tests might be
misleading at a low bacterial density. Thus, the debate
continues regarding the most appropriate H. pylori diag-
nostic method in atrophic gastritis.
Lan et al[18]
aimed to evaluate the site and sensitivity
of biopsy-based tests in terms of degree of gastritis with
atrophy. Biopsy-based tests (i.e., culture, histology Giemsa
stain and RUT) and non-invasive tests (anti-H. pylori IgG)
were performed in 164 uninvestigated dyspepsia patients.
The sensitivity of biopsy-based tests decreased when the
degree of gastritis with atrophy increased, regardless of
biopsy site. In moderate to severe antrum or body gastri-
tis with atrophy, additional corpus biopsy increased the
sensitivity to 16.67%, as compared with single antrum
biopsy. These results confirm that in moderate to severe
gastritis with atrophy, biopsy-based test should include
the corpus for avoiding false negative results in H. pylori
detection.
Since the discovery of H. pylori, pathologists have
used different diagnostic techniques, including immu-
nohistochemical (IHC) methods and special stains, such
as Giemsa and Warthin-Starry, on an institution- and
laboratory-dependent basis (with variable sensitivities and
specificities for identifying H. pylori). On the other hand,
it is clear that IHC staining is highly sensitive and specific
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Lopes AI et al. H. pylori diagnosis advances
5. De Martel et al[27]
, using data from a large Venezuelan
cohort of 1948 adults, compared the gastric detection of
H. pylori by polymerase chain reaction (PCR) of the vacA
gene in one antral biopsy, to the detection of H. pylori by
histopathology (HE and Giemsa staining) in five biopsies
(antrum and corpus). Overall, H. pylori was detected in
85% and 95% of the subjects by PCR and histopathol-
ogy, respectively, thus confirming that histopathology on
five biopsies is an accurate tool for H. pylori detection in
most subjects, compared with the PCR method on one
biopsy. However, in subjects with the most severe pre-
cancerous lesions (intestinal metaplasia type Ⅲ and dys-
plasia), PCR displayed elevated sensitivity for detecting
the bacteria (significantly more often than histopathology
on a single biopsy), thus suggesting its potential useful-
ness in this setting.
Tian et al[28]
reported a meta-analysis evaluating H. py-
lori diagnostic methods in patients with a partial gastrec-
tomy. The pooled sensitivity and specificity were 93 and
85% for histology, 77 and 89% for UBT, and 79 and 94%
for RUT, respectively, thus leading to the conclusion that
histology was the most reliable test in this setting. Lee et
al[4]
evaluated 91 patients requiring endoscopic mucosal
resection for early gastric cancer (GC), obtaining three
pairs of biopsies from the antrum, CLC and CGC. The
sensitivity of histology in detecting H. pylori was signifi-
cantly higher in the CGC than that in the antrum or CLC,
suggesting that the CGC might be the optimal biopsy site
for H. pylori in patients with extensive atrophy.
The utility of routine biopsy of the gastric ulcer mar-
gin (currently performed to exclude malignancy) in diag-
nosing H. pylori infection, has recently been re-assessed
by Lin et al[29]
, by examining prospectively a cohort of 50
patients with gastric ulcer (54% uninfected). Histology,
RUT and UBT were compared; six biopsied specimens
from the margin of the gastric ulcer and one specimen
each from the antrum and body of non-ulcerous parts
were obtained for histology using HE staining. The di-
agnostic accuracy of the histological examination of the
ulcer margin was quite good and importantly, the addi-
tion of one specimen from the antrum or body did not
increase its diagnostic yield, thus emphasizing its accuracy
and usefulness for diagnosing H. pylori infection in these
patients.
An increasing body of evidence supports H. pylori
colonization in the esophageal mucosa of dyspeptic pa-
tients. Contreras et al[30]
have further contributed to the
field, with a study examining the presence of H. pylori in
the gastroesophageal mucosa by histology, fluorescence
in situ hybridization (FISH) and PCR analysis of DNA
(using genus- and species-specific PCR primers) extracted
from gastric and esophageal biopsies of 82 symptomatic
Venezuelan patients. H. pylori in the stomach was de-
tected by PCR and FISH, respectively, in 61% and 90%
of dyspeptic patients, and in the esophagus in 70% and
73%. By combining the results of both methods, H. pylori
was observed in the gastroesophageal mucosa in 86% of
patients. These findings deserve specific attention and
further elucidation.
Finally, the histology reporting of gastritis of the
staging system OLGA (Operative Link on Gastritis As-
sessment) has also been re-examined, considering its
relevance to the prediction of the gastric cancer risk[31,32]
.
Carrasco et al[33]
reviewed the histology of the normal
gastric mucosa, overviewing the role of H. pylori in the
multistep cascade of GC. The role of the OLGA staging
system in assessing the risk of GC was emphasized; spe-
cifically, the epigenetic bases of chronic gastritis, mainly
DNA methylation of the promoter region of E-cadherin
in H. pylori - induced chronic gastritis and its reversion af-
ter H. pylori eradication. In addition, the authors discussed
the finding of circulating cell-free DNA, offering the op-
portunity for non-invasive risk assessment of GC.
Rapid Urease Test
The RUT is based on the production of large amounts
of urease enzyme by H. pylori, which splits the urea test
reagent to form ammonia, enabling its detection by a
rapid indirect test. Many commercial RUTs are available,
including gel-based tests, paper-based tests and liquid-
based tests, providing a result in 1-24 h, depending on the
format of the test and the bacterial density in the biopsy
specimen. Typically, commercial RUTs have specificities
above 95%-100%; however, the sensitivity is slightly less,
ranging from 85%-95%[34]
.
Compared with histology and culture, urease tests
are faster, cheaper and have comparable sensitivity and
specificity in normal clinical settings. The sensitivity can,
however, decrease in patients with bleeding peptic ulcers
(67%-85%), as well as in patients with partial gastrectomy
(79%)[24,28,34,35]
. Formalin contamination of forceps used
to collect the biopsy may also contribute to reduced sen-
sitivity[24,36]
.
An important conclusion of several studies is that
enhancing the number of biopsy fragments and/or col-
lecting them from various regions of the stomach (antrum
and body, from example), achieves a higher sensibility of
the RUT[37]
. Moreover, it was shown recently that com-
bining tissues prior to RUT increased the detection of
H. pylori, compared with testing separate specimens, and
produced faster results[38]
.
CULTURE
Since the discovery of H. pylori, bacterial culture has been
used as routine diagnostic test, being considered the gold
standard. Currently, the Maastricht-4 Consensus Report
recommends H. pylori culture for performing antibiotic
susceptibility testing if primary resistance to clarithro-
mycin is higher than 20% or after failure of second-line
treatment[17]
.
Despite its long use, culture tests remain a challenge
because of the fastidious nature of the bacterium, with
particular growth requirements of medium and atmo-
sphere. The most commonly used media include Bru-
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Lopes AI et al. H. pylori diagnosis advances
6. cella, Columbia Wilkins-Chalgren, brain-heart infusion or
trypticase agar bases, supplemented with sheep or horse
blood[39]
. An alternative to blood is supplementation of
the agar base with b-cyclodextrin or yolk emulsion[40,41]
.
The most recent advances on H. pylori culture concern
growth medium composition, besides the usual serum or
blood additives. A recent study showed that supplemen-
tation of media with cholesterol instead of serum was
a viable option for H. pylori growth[42]
. Another original
approach used liquid culture medium for the rapid cul-
tivation and subsequent antibiotics susceptibility testing
of H. pylori directly from biopsy specimens, with a final
detection step by an enzyme linked immunosorbent assay
(ELISA)[43]
.
Concerning the growth atmosphere, H. pylori is a cap-
nophilic organism that requires an atmosphere enriched
with CO2 (varying from 5%-10%). In addition, it has
been considered a microaerophile, but there is no general
consensus about its specific O2 requirements[44]
. A recent
advance on this topic was made by Park et al[45]
, who
showed that unlike previous reports, H. pylori may be a
capnophilic aerobe whose growth is promoted by atmo-
spheric oxygen levels in the presence of 10% CO2.
Typically, culture of H. pylori is performed on gastric
biopsy samples, and because bacteria display an irregular
distribution in the gastric mucosa, culture of more than
one biopsy, from the antrum and corpus, is sometimes
mandatory, especially after antibiotic treatment. Another
important issue to bear in mind are factors that may af-
fect the outcome of H. pylori culture from endoscopic
gastric mucosal specimens. Besides the issue concern-
ing bleeding peptic ulcers, for which culture has a lower
sensitivity than in nonbleeding cases, other host-related
factors, such as high activity of gastritis, low bacterial
load, drinking alcohol and the use of histamine H2 recep-
tor blockers, have been recently described as the cause of
failed H. pylori culture from gastric mucosa in the infected
subjects[24,46]
.
Culturing from stools has been shown to be extreme-
ly difficult because of the complex nature of the sample
regarding microbiota composition and shedding of unvi-
able H. pylori cells, and this technique has been successful
in the setting of rapid gastrointestinal tract transit[47]
. In
a recent study, the authors were able to culture H. pylori
in nine and 12 rectal and ileal fluids, respectively, after
polyethylene glycol (colyte) ingestion in 20 healthy adults
with positive UBT[48]
. Other studies have looked for the
role of the oral cavity as a reservoir of H. pylori. A recent
work evaluated the occurrence of the organism in subgin-
gival plaque and was able, by culture, to recover H. pylori
in nine of 30 studied patients that were H. pylori positive
with RUT and histopathological examination. Thus, they
concluded that detection of H. pylori in dental plaque of
dyspeptic patients cannot be neglected and might repre-
sent a risk factor for recolonization of the stomach after
systemic eradication therapy[49]
. The same conclusion was
reached by another study in which H. pylori was detected
in subgingival dental plaque of children and their families,
possibly acting as a “reservoir” contributing to the intra-
familial spread[50]
.
MOLECULAR METHODS
Diagnostics tests rely more and more on molecular tests,
which can provide faster, more accurate and sensitive
detection of the bacterium than conventional methods,
with the possibility of extension to other purposes, such
as detection of antibiotic resistance and virulence de-
terminants, and bacterial quantification. Moreover, bio-
logical samples other than gastric biopsies can be used,
obtained using less invasive methods, such as stool or
oral cavity samples. Whatever the case, amplification of
the nucleic acids by PCR is almost always present, either
conventional PCR or, increasingly, by real-time PCR.
H. pylori, like a few other bacteria, acquires resistance
by mutation, which has enabled the development of
numerous assays, in several formats, to detect mutations
leading to resistance, especially to macrolides and fluoro-
quinolones. To detect H. pylori and resistances to fluoro-
quinolones and clarithromycin, there is a multiplex PCR
followed by a hybridization and alkaline phosphatase
reaction on a membrane strip (the Genotype®
HelicoDR
kit), that uses as a starting material biopsy specimens, as
well as culture material extracted from it. The test shows
a high sensitivity and permits detecting infection with
multiple strains. The performance in detecting fluoroqui-
nolone-resistance strains was, however, lower than cul-
ture, emphasizing the need to expand the range of gyrA
mutations included in the kit[51,52]
. Several real-time PCR
based assays, using either TaqMan or FRET (Fluorescence
Resonance Energy Transfer) are available, as in-house
assays or commercial kits, for clarithromycin resistance,
performed on cultured strains, directly on biopsies[53-55]
or
in stool samples. The latter is particularly useful as a non-
invasive test in pediatric populations, where a high preva-
lence of clarithromycin-resistant strains is suspected,
as well as for tracking the emergence of clarithromycin
resistance following eradication treatment[57,58]
.
Recently, a dual-priming oligonucleotide (DPO)-based
multiplex PCR was developed to detect both H. pylori
infection and the most common point mutations confer-
ring resistance to clarithomycin, directly on gastric biopsy
specimens. This assay proved to be fast and does not
require expensive instrumentation, making it valuable in
countries with a high prevalence of clarithromycin resis-
tance[59,60]
.
The detection of clarithromycin-resistance from for-
malin-fixed, paraffin-embedded gastric biopsies has also
been described, and is useful mostly before treatment
when culture and susceptibility testing is not available, or
to detect primary resistance to clarithromycin in the case
of failure of an empirical therapy based on this antibiotic.
Real-time PCR assays, as well as a peptide nucleic acid-
fluorescence in situ hybridization (PNA-FISH) method,
have been described recently[61-63]
.
Another area of particular interest is the detection
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Lopes AI et al. H. pylori diagnosis advances
7. of virulence determinants, such as the cagA (cytotoxin-
associated gene A) and the vacA (vacuolating cytotoxin)
major toxins. Several studies showed that the risk of
progression of gastric preneoplastic lesions is higher in
patients infected with strains harboring the most virulent
cagA and vacA genotypes than in patients infected with
the least virulent strains. Therefore, H. pylori genotyping
may be useful to identify patients at high risk of progres-
sion of gastric preneoplastic lesions and who need more
intensive surveillance[64]
. Concerning vacA, a novel meth-
od for genotyping the vacA intermediate gene region
was reported recently, using a novel primer combination
allowing the amplification of smaller DNA fragments
than the original PCR, which can therefore be applied to
paraffin-embedded biopsies. Patients infected with vacA
i1 strains showed an increased risk of gastric atrophy and
gastric carcinoma, with odds ratios of 8.0 (95%CI: 2.3-27)
and of 22 (95%CI: 7.9-63)[65]
.
CagA undergoes phosphorylation on tyrosines within
the Glu-Pro-Ile-Tyr-Ala (EPIYA) motifs at the poly-
morphic C-terminus[66]
. Several studies suggest a role for
the polymorphic CagA EPIYA-containing region in the
pathogenicity of H. pylori, although conflicting results
have been reported[67,68]
. The in vivo role of this region
was emphasized recently in a study showing that infection
with strains harboring two or more CagA EPIYA C mo-
tifs was associated with the presence of surface epithelial
damage, and with atrophic gastritis and gastric carcinoma.
Moreover, the presence of two or more CagA EPIYA C
motifs increased the risk of atrophic gastritis from 7.3
(95%CI: 2.1-25) to 12 (95%CI: 2.5-58) and of gastric car-
cinoma from 17 (95%CI: 5.4-55) to 51 (95%CI: 13-198),
when compared with one EPIYA C motif. Therefore, ge-
notyping H. pylori virulence determinants could represent
a useful approach in defining severe gastric-disease risk.
Bacterial quantification can also be important for
clinical management of the infection; for example, for
monitoring the treatment outcome or in particular set-
tings, such as upper gastrointestinal bleeding[69]
.
A recently developed real-time quantitative PCR assay
based on H. pylori ureC (single copy gene) copy number
proved to be around 10 times more sensitive than the
conventional PCR method. Moreover, the copy number
of ureC was significantly increased when overall gastritis,
bacterial density, chronic inflammation and intestinal
metaplasia were present[70]
. Nevertheless, further studies
are necessary to determine the optimum cut-off point,
making it possible to differentiate between asymptom-
atic colonization and infection with clinical implications
for patients. These highly sensitive real-time quantitative
PCRs can have a large application on the study of envi-
ronmental reservoirs as well[71,72]
.
By improving our knowledge of bacteria, at the mo-
lecular level, new strategies for treatment/prevention of
bacterial-associated diseases, as well as diagnostic tests,
can be developed. Proteomic approaches aimed at identi-
fying gene products differentially expressed in association
with a given pathology can provide an important input
towards understanding the pathways that are associated
with the respective disease, contributing to the identifica-
tion of novel therapeutic or diagnostic targets.
Our current knowledge on the proteome of this or-
ganism is largely based on data obtained for the soluble
proteome[73]
, membrane proteome[74,75]
and secreted pro-
teome[76]
of strain 26695, the first isolate to be sequenced.
More recently, relevant contributions have made been
through this approach, such as novel biomarkers for gas-
tric cancer and for peptic ulcer disease[77,78]
.
NONINVASIVE TESTS
Although the reliability of both the 13
C-UBT and a
monoclonal ELISA stool test (HpSA) to diagnose H. py-
lori infection in very young children has been confirmed,
additional background information is warranted for epi-
demiological studies in infants and toddlers.
UREA BREATH TESTS
The 13 C-urea breath test (13
C-UBT) is one of the most
reliable tests for diagnosing H. pylori infection. It is a
non-invasive, simple and safe test that provides excellent
accuracy both for the initial diagnosis of H. pylori infec-
tion and for the confirmation of its eradication after
treatment. The simplicity, good tolerance and economy
of the citric acid test meal probably make its systematic
use advisable. The UBT protocol may be performed with
relatively low doses (< 100 mg) of urea: 75 mg or even
50 mg seem to be sufficient. With the most widely used
protocol (with citric acid and 75 mg of urea), excellent
accuracy is obtained when breath samples are collected
as early as 10-15 min after urea ingestion. A unique and
generally proposed cut-off level is not possible, because
it has to be adapted to different factors, such as the test
meal, the dose and type of urea, or the pre-/post-treat-
ment setting. As positive and negative UBT results tend
to cluster outside of the range between 2 and 5, a change
in cut-off value within this range would be expected to
have little effect on the clinical accuracy of the test[79,80]
.
UBT is now marketed for use with a nondispersive,
isotope-selective infrared spectroscope or laser-assisted
ratio analysis, which are reliable and valid alternatives to
isotope ratio mass spectrometry (IRMS) of potential in-
terest for epidemiologic studies of children, for screening
symptomatic children before endoscopy or assessment
of treatment efficacy. These devices are far smaller and
cheaper, and they allow for in-office, near-immediate
reading of results. Validation studies to establish the cut-
off value for this test were preliminarily performed in
Japan[81]
; however, further data are needed[82,83]
.
The 13
C-UBT in adults has a high sensitivity
(88%-95%) and specificity (95%-100%)[17]
. However, the
test has shown heterogeneous accuracy in the pediatric
population, especially in young children, with values of
sensitivity and specificity ranging from 75% to 100%,
before and after treatment (using several protocols),
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Lopes AI et al. H. pylori diagnosis advances
8. despite being a simple and safe non-invasive test in chil-
dren older than 6 years old[84]
. Although several modifi-
cations have been proposed since the original descrip-
tion by Graham of the 13
C-UBT to diagnose H. pylori
infection[85]
, in children, performance criteria are not yet
sufficiently established[86]
. In the specific age group of
younger children, accurate non-invasive tests for diag-
nosing H. pylori infection are required, as they may avoid
invasive and painful procedures, such as endoscopy and
blood sampling, and to overcoming the false negative
results observed with gold standard tests (histology, cul-
ture, and RUT), where colonization of the stomach may
be weak and patchy.
Potential explanations for UBT performance vari-
ability in children might include: (1) urease activity from
the oral bacterial flora[87]
; (2) differences in delta time
(decrease in specificity if samples obtained at 15 min in-
stead of 30 min); and (3) variability in cut-off values. The
administration of 13
C-urea in capsules to avoid activity of
oral bacteria, though effective in adults, is not feasible in
infants or toddlers[88]
. Finally, the cut-off value (usually
determined by a ROC curve) represents a crucial factor
for the accuracy of the test, where low cut-off values
might increase sensitivity but reduce specificity, and vice
versa[81]
. Additionally, the individual’s CO2 production is
influenced by anthropometric characteristics, as well as by
age and sex (lower in young children with relatively low
weight and height)[89]
.
Leal et al[90]
performed an informative systematic
review and meta-analysis (31 articles and 135 studies
from January 1998 to May 2009), aiming to evaluate the
performance of the 13
C-UBT diagnostic test for H. pylori
infection in children. Studies with at least 30 children
and reporting the comparison of 13
C-UBT against a gold
standard for H. pylori diagnosis (H. pylori culture, histo-
logic examination, or RUT) were included for analysis.
Children were stratified in subgroups of < 6 and ≥ 6
years of age. The 13
C-UBT performance meta-analyses
showed: (1) good accuracy in all ages combined [sensitiv-
ity 95.9%, specificity 95.7%, diagnostic odds ratio (DOR)
424.9]; (2) high accuracy in children > 6 years (sensitivity
96.6%, specificity 97.7%, DOR 1042.7); and (3) greater
variability in accuracy estimates and a lower specificity
in children ≤ 6 years (sensitivity 95%, specificity 93.5%,
DOR 224.8). The authors identified as potentially impor-
tant sources of heterogeneity: (1) tracer dose; (2) pretest
meal; and (3) cut-off value, observing that a unique
tracer dose of 50 mg of 13
C-urea showed greater accu-
racy when it was adjusted to body weight (50-75 mg were
used between studies). Accordingly, Mégraud[91]
previ-
ously reported that reducing the dose from 75 to 45 mg
in younger children resulted in improved specificity. Al-
though citric acid has demonstrated good performance in
adults, it is not well accepted by children, and apple, or-
ange, or grape juice seem to be good alternatives. Finally,
a cut-off value of 6.0‰ improved overall performance in
children younger than 6 years, as compared to a cut-off
of 4.0 ‰ for children older than 6 years.
Pacheco et al[92]
evaluated the diagnostic accuracy of
detecting H. pylori infection of low dose 13
C-UBT with
early sampling at pediatric age (129 patients between the
ages of 2.1 and 19 years old, median = 11.6 years) sub-
mitted to upper gastrointestinal endoscopy. The 13
C-UBT
was performed after a 4-h fasting period with four points
of collection: baseline (T0, at 10, 20 and 30 min) after
ingestion of 25 mg 13
C-urea diluted in 100 mL of apple
juice; analysis of exhaled breath samples was performed
with an isotope-selective infrared spectrometer. The sen-
sitivity and specificity were similar at T10, T20 and T30
(94.7%/96.8%; 96.2%/96.1% and 96.2%/94.7%, respec-
tively).
Recently, Queiroz et al[93]
investigated the agreement
between the 13
C-UBT and a monoclonal ELISA (HpSA)
to detect H. pylori antigen in stool in a prospective study
enrolling 414 South-American infants (123 from Brazil
and 291 from Peru) aged 6-30 mo. Breath and stool sam-
ples were obtained at intervals of at least three-months.
13
C-UBT and stool test results concurred with each other
in 94.86% cases (kappa coefficient = 0.90, 95%CI: 87-92).
In the H. pylori-positive group, DOB and OD values were
positively correlated (r = 0.62, P < 0.001, suggesting that
both 13
C-UBT and stool monoclonal test are reliable to
diagnose H. pylori infection in very young children.
In contrast to pediatric studies, where attention has
been focused on methodological issues, in adult studies,
the validity and usefulness of UBT have increasingly been
evaluated in a wide spectrum of specific clinic settings.
Olafsson et al[94]
evaluated 620 UBT in 595 subjects at a
gastroenterology clinic. UBT was negative in 526 patients,
but: (1) 45% patients were tested < 4 wk before the end
of treatment; and (2) 23% of negative results occurred
in patients recently treated. The authors emphasized the
need for strict protocol adherence in clinical practice for a
fully reliable UBT assessment. Velayos et al[95]
investigated
the accuracy of UBT performed immediately after emer-
gency endoscopy in 74 patients with peptic ulcer bleeding
by comparing the results with those of UBT performed
after hospital discharge in a subset of 53 patients (gold
standard). Although UBT carried out immediately after
emergency endoscopy in peptic ulcer bleeding is an ef-
fective, safe and easy-to-perform procedure, the relatively
low sensitivity and specificity suggested the requirement
of a subsequent control, in accordance with recommen-
dations concerning peptic ulcer bleeding[96]
.
Few studies using UBT have been performed in pa-
tients subjected to a partial gastrectomy, a specific group
in which the identification of H. pylori infection is mostly
relevant. Wardi et al[97]
evaluated the sensitivity and speci-
ficity of the continuous UBT (BreathID) in 76 post gas-
trectomized patients (older than 18 years) (lowering the
gastric pH by the addition of citric acid), against RUT
and histology as gold standards. H. pylori was positive in
14/76 (18.4%) patients when histology was considered as
the gold standard method. The positive predictive values
of the continuous UBT and the RUT were 0.64 and 0.35,
respectively. The negative predictive value was high by
9306 July 28, 2014|Volume 20|Issue 28|WJG|www.wjgnet.com
Lopes AI et al. H. pylori diagnosis advances
9. both the methods, 0.92 and 0.95, respectively, supporting
the view that BreathID might have some reliability to ex-
clude H. pylori after partial gastrectomy.
STOOL ANTIGEN TESTS
The stool antigen test is a non-invasive method to detect
H. pylori, usually recommended when the UBT is not
available[98]
. Besides being non-invasive, the advantages
of using this method include the unneeded requirement
of expensive equipment and medical personnel, and the
collection of the sample at home without a visit to the
hospital. This method is especially relevant for children’s
access to a safe diagnosis and also for its low cost[99,100]
.
A meta-analysis revealed that the global sensitivity and
specificity of stool antigen tests are 94% (95%CI: 93-95)
and 97% (95%CI: 96-98), respectively[101]
. A prospective
study to evaluate the efficacy of a new EZ-STEP H. py-
lori polyclonal enzyme immunoassay (EIA) stool antigen
test enrolled 555 patients undergoing routine checkups.
At the optimal cut-off value (optical density 0.160), this
test presented high level of sensitivity (93.1%), specificity
(94.6%) and accuracy (93.8%)[99]
.
There are two types of stool antigen tests used for
H. pylori detection, the EIA and an assay based on immu-
nochromatography. Two new stool tests were developed
recently[102]
. These tests are the Testmate pylori antigen
EIA, in which plastic 96-well EIA microtiter plates are
coated with monoclonal antibody (Mab) 21G2[103]
, and
the Testmate rapid pylori antigen, which is based in im-
munochromatography and is presented as a test strip. For
the EIA test, a drop of the suspended stool sample or a
sample of the diluted bacterial antigen sample is mixed
with the peroxidase-conjugated MAb 21G2. After proper
incubation and washing, the optical density is measured
and considered positive if greater than 0.100. For the test
strip, a drop of stool sample is applied in the specimen
application of the test strip. When H. pylori antigens are
present, they form immune complexes with the red latex-
labeled MAb 21Ge and migrate by capillarity action until
captured by the solid phase anti-mouse rabbit polyclonal
antibodies and form a visible red test line. A control line
is also present. After application of these tests to 111
stool samples, both new tests provide 100% specific-
ity, sensibility and accuracy[102]
, which is very promising.
However, not all studies report these high values for sen-
sitivity and specificity. For example, the report of Chehter
et al[100]
analyzed the stools of 75 patients and determined
a lower sensitivity (87.2%) and specificity (44%); Irani-
khah et al[104]
analyzed the stools of 103 children and ob-
tained similar values for sensitivity (85%), but improved
specificity (83%).
Recently, five different stool antigen tests were com-
pared: the Premier Platinum HpSA Plus test (based on
monoclonal EIA; Meridian Bioscience, Inc, Cincinnati,
OH, United States); the Hp Ag test (based on monoclo-
nal EIA; Dia.Pro Diagnostic Bioprobes Srl, Milano, Italy);
the ImmunoCard STAT! HpSA test (based on monoclo-
nal lateral flow chromatography (LFC); Meridian Biosci-
ence, Europe Srl Milano, Italy); the H. pylori fecal antigen
test (based on monoclonal LFC; Vegal Farmaceutica, Ma-
drid, Spain) and the one-step H. pylori antigen (based on
LFC with polyclonal antibodies; IHP-602, ACON Labo-
ratories, Inc, San Diego, United States). Data comparison
showed an uneven performance, favoring the Premier
Platinum HpSA Plus test (sensitivity 92.2%; specificity
94.4%). The selection of the stool antigen assay is very
important to achieve accurate results.
Stool antigen tests are also useful to detect H. pylori in
infected animal models, such as C57BL/6 mice[105]
.
Antibody - based tests
Serology was one of the first methods used for diagnosis
of H. pylori infection[106]
. Currently, serology is recom-
mended for initial screening, requiring further confirma-
tion by histology and/or culture before treatment[107]
.
Detection of antibodies is useful for detecting past or
present exposure. In fact, a limitation of serology tests
is the failure to distinguish between past and current H.
pylori infection[99]
. Moreover, the antibody levels to H.
pylori are significantly heritable. Thus, individual genetic
differences of the human host contribute substantially to
antibody levels to H. pylori[108]
.
Serological tests have several advantages, namely they
are non-invasive and they do not produce false negative
results in patients receiving treatment (proton pump in-
hibitors and antibiotics) or presenting acute bleeding[109]
.
Blood samples are used for serology testing, detect-
ing anti-H. pylori antibodies (IgG) by ELISA. Recently,
the performance of 29 different serological tests kits was
compared, revealing sensitivities ranging from 55.6% to
100%, specificities ranging from 59.6% to 97.9 %, posi-
tive predictive values ranging from 69.8% and 100%,
and negative predictive values ranging from 68.3% and
100%[106]
. According to the goal, such as screening, initial
diagnosis and confirmation of another test, the most ap-
propriate kit should be chosen. Antibody-based tests for
the detection of H. pylori are easily available, but present
high negative predictive value[110]
. The heterogeneity of H.
pylori strains has been well documented, with considerable
variation in the prevalence of specific strains, especially
from different geographical areas[111-113]
; thus, the success
of a serology test depends on the use of antigens that
are present in H. pylori strains from a given population.
Moreover, kits developed using H. pylori strains from
the west are not suitable for detecting H. pylori infection
in the East[114]
. The use of high-molecular-weight cell-
associated antigens that are conserved in H. pylori strains
overcomes this limitation[115]
. Several H. pylori immuno-
genic proteins have been presented as candidates to de-
tect infection, such as the FlidD protein[116]
; multiple re-
combinant (CagA, VacA, GroEL, gGT, HcpC and UreA)
proteins[116]
; CagA[115]
or Omp18[117]
.
Modifications to serology tests have been suggested,
such as the automated immunoaffinity assay for H. pylori
9307 July 28, 2014|Volume 20|Issue 28|WJG|www.wjgnet.com
Lopes AI et al. H. pylori diagnosis advances
10. IgG detection using purified antigen of H. pylori immobi-
lized on magnetic nanobeads, which is faster than ELISA
and requires a smaller volume of serum[118]
. The lateral
flow immunoassay, an immunochromatographic assay,
maintains the serological approach with the advantage of
being fast, economic and requiring no additional equip-
ment or experience[119]
.
Detection of gastrin and the serum PG Ⅰ/Ⅱ ratio
combined with H. pylori serology is useful to predict
gastric preneoplastic conditions[110]
. The PG Ⅰ/Ⅱ ratio
decreases with advancing extensive atrophic gastritis,
since PG I is produced by chief and mucous neck cells in
the fundus glands, which are impaired in case of gastritis
of the fundus; while PG Ⅱ is produced by the former
cells and also by cardiac, pyloric and duodenal Brunner’s
glands[120]
.
DETECTION OF H. PYLORI IN OTHER
SPECIMENS
Other specimens have been evaluated to determine their
usefulness to detect H. pylori infection. These include sa-
liva[121,122]
, subgingival biofilm[123]
, dental plaque[124]
, gastric
juice, gastroesophageal biopsies[125]
and adenotonsillar
tissue[126]
. Contradictory results have been reported re-
garding H. pylori detection in adenotonsillar tissue, either
favoring[127]
or against[126]
adenotonsillar tissue as an extra-
gastric reservoir of H. pylori. The ability to detect H. pylori
antibodies in saliva is lower than in blood-based serology.
However, the use of molecular techniques for the detec-
tion of H. pylori infection in saliva or dental plaque may
make these specimens attractive because they are easier to
collect[114]
. The molecular techniques include PCR[122,123]
and PCR-denaturing gradient gel electrophoresis (PCR-
DGGE)[128]
. Other techniques used to analyze these spec-
imens are the RUT, immunohistochemistry and PNA-
FISH[126]
.
The enterotest or string test was designed decades
ago specially for children. The string test consists of a
gelatin capsule attached to a 90-140 cm long nylon string
that unwinds during ingestion. Upon reaching the stom-
ach, the gelatin capsule dissolves and the string absorbs
gastric secretions. The extraction of the string occurs
30-180 min later and should avoid contact with teeth and
tongue to prevent contamination. The string may be used
for culture (sensitivity 65% and specificity 99%) or PCR
(sensitivity 79% and specificity 99%) for H. pylori detec-
tion[129]
.
CONCLUSION
Recent developments in both biopsy- and non-biopsy-
based diagnostic methods for H. pylori infection will
further contribute to improving current clinical approach
and management of H. pylori-associated diseases.
We predict that in the future, standard and newer
methods will evolve to improve the diagnostic yield of H.
pylori infection detection in specific age groups (children
versus adults) and clinical conditions, such as peptic ulcer
bleeding, atrophic gastritis, post-gastrectomy status, as
well as for wider application in epidemiological studies.
The specific contribution of each method to the evolving
strategies and algorithms for evaluation and management
of H. pylori infection (test and treat) will remain of para-
mount relevance.
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E- Editor: Zhang DN
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