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Helicobacterdiagnosisofhelicobacterpylori PDF
Helicobacterdiagnosisofhelicobacterpylori PDF
Helicobacterdiagnosisofhelicobacterpylori PDF
Cirak
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Diagnosis
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Blackwell
Oxford,
1083-4389
Helicobacter
HEL
Journal
XXX
2007
The
2007 Blackwell Publishing Ltd, Helicobacter 12 (Suppl. 1): xxxx
Keywords
Endoscopy, urea breath test, stool antigen test,
serology, molecular methods.
Reprint requests to: Francis Mgraud, INSERM
U853, Bordeaux, F 33076 France.
E-mail: francis.megraud@chu-bordeaux.fr
Abstract
Although there are attempts to perform Helicobacter pylori diagnosis directly
in vivo using magnification endoscopy, most articles on diagnosis this year
concerned non-invasive tests and molecular methods. For urea breath tests,
there are attempts to have a quicker and cheaper test and to evaluate its role in
cases of premalignant lesions. For stool antigens tests, evaluation of kits using
monoclonal antibodies was carried out. Molecular tests have been applied for
typing and detection of resistant mutants.
Endoscopy
Among the new methods of magnifying endoscopy, a
prototype of endocytoscopy developed by Olympus was
used for ex vivo visualization of Helicobacter pylori on
experimentally infected gastric biopsies. Moving bacteria
were observed at 1100 magnification, giving hope for a
possible direct detection during endoscopy [1]. Kim et al.
also used magnifying endoscopy on 103 patients to classify
the gastric surface according to four patterns: flat, irregular,
papillary or nonstructured, which were then compared to
the updated Sydney System for histologic gastritis. Histologic
gastritis was found in 91% of the biopsy sections with a
nonflat type, and among them, 96% were confirmed to
harbor H. pylori infection [2]. In another study, the
magnified endoscopic findings in the gastric body were
classified into four patterns and then correlated with
histology results. Type 1 pattern corresponded to normal
gastric mucosa, types 2 and 3 to H. pylori-infected mucosa
and type 4 to atrophy. The sensitivity and specificity for
these endoscopic findings were 92.7% and 100% for
type 1, and 100% and 92.7% for types 2 and 3 together,
respectively [3].
Cirak et al.
Diagnosis of H. pylori
specificity were 94% (95% CI: 9395) and 97% (95% CI:
9698), respectively. In 13 studies where polyclonal
antibody-based stool antigen tests were compared to
monoclonal antibody-based tests, a higher sensitivity was
shown for the latter (95% vs. 83%). Twelve studies including a total of 957 patients assessed monoclonal antibodybased tests post-eradication, with pooled sensitivity and
specificity of 93% (95% CI: 8996) and 96% (95% CI:
9497), respectively; again they showed a better sensitivity
than polyclonal antibody-based tests (91% vs. 76%) in
eight studies when both were performed.
In studies published this year, however, the results are
not generally good. HpSTAR (Dako, Glostrup, Denmark)
provided good results in some studies [2830] but not in
others. The pretreatment specificity was low in a study
by Dominguez et al. [31] as was the post-treatment
sensitivity as reported by Quesada et al. [32]: 70.7% and
73%, respectively.
Immunocard HpSA (Meridian, Diagnostic, Cincinnati,
OH, USA) is a point-of-care test also using monoclonal
antibodies. It had a good accuracy (96%) in a pediatric
study [28] but a low sensitivity in adults according to
Hooton et al. (79%) [29] and a low specificity according to
Lu et al. (82.8%) [33]. Both sensitivity and specificity were
satisfactory in another study (91% and 97%, respectively).
Antibody Detection
Diagnosis of H. pylori
Molecular Methods
Molecular methods are widely used for the diagnosis of
H. pylori infection as well as analyses of diversity, virulence,
persistence and resistance patterns of these bacteria. Minami
et al. proposed a novel and quick identification system for
H. pylori which is a combination of the endoscopic brushing
technique and the loop-mediated isothermal amplification
method (LAMP). Among the samples from 200 patients,
123 brushing samples were H. pylori positive using LAMP
primers constructed for the glmM gene within a 90-minute
detection time with 100% sensitivity and specificity, whereas
100 patients were positive when only biopsy samples were
tested [45].
Typing
Cirak et al.
Antimicrobial Resistance
Cirak et al.
Diagnosis of H. pylori
Conicts of interest
The authors have declared no conflicts of interest.
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