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Anand PS, Kamath KP, Gandhi AP, Shamim MA, Padhi BK, Das S. Dental plaque as an extra-gastric reservoir of Helicobacter pylori: A systematic review and meta-analysis. Arch Oral Biol 2025; 170:106126. [PMID: 39556904 DOI: 10.1016/j.archoralbio.2024.106126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 11/01/2024] [Accepted: 11/06/2024] [Indexed: 11/20/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis (SRMA) aimed to determine whether the presence of H. pylori in dental plaque is associated with gastric H. pylori infection. DESIGN Search for the relevant literature was done in various databases: PubMed, Embase, Web of Science and Cochrane till September 21, 2023. The studies were screened for outcome of interest i.e. gastric H. pylori infection and exposure of interest i.e. H. pylori positivity in dental plaque. The pooled results of the study outcomes were evaluated using Odds Ratio (OR), accompanied by a 95 % confidence interval (CI). To evaluate the heterogeneity among studies, I2 statistics were utilized, with an I2 exceeding 50 % indicating a significant to high variation. In cases where I2 was greater than 50 %, a random-effects model (specifically, the Der Simonian and Laird method) was employed. RESULTS Data from 27 observational studies and 2408 participants were included. The pooled OR of the H. pylori positivity in dental plaque among the patients with H. pylori positivity in stomach was 3.80 (95 % CI 2.24; 6.43), with high heterogeneity (I2= 69 %, p<0.01). Sensitivity analysis after removing the outliers reduced the heterogeneity significantly (I2=22 %, p=0.16). Meta-regression revealed that the strength of association did not vary according to the year of study or the sample size included in the studies. Overall certainty of the evidence was low. CONCLUSIONS The present meta-analysis showed that the presence of gastric H. pylori infection was higher among patients with H. pylori in dental plaque compared to patients without H. pylori in dental plaque. Presence of H. pylori infection in dental plaque can have implications in the management of H. pylori infection as dental plaque can serve as a reservoir from which the microorganism can recolonize the gastric mucosa.
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Affiliation(s)
- Pradeep S Anand
- Department of Dentistry, ESIC Medical College & Hospital, Hyderabad, India.
| | - Kavitha P Kamath
- Department of Dental Research Cell, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Aravind P Gandhi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India.
| | | | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sakshi Das
- Department of Dentistry, ESIC Medical College & Hospital, Hyderabad, India
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Yuksel Sert S, Ozturk A, Bektas A, Cengiz MI. Periodontal treatment is more effective in gastric Helicobacter pylori eradication in those patients who maintain good oral hygiene. Int Dent J 2019; 69:392-399. [DOI: 10.1111/idj.12484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Di Bonaventura G, Neri M, Angelucci D, Rosini S, Piccolomini M, Piccolomini R. Detection of Helicobacter Pylori by PCR on Gastric Biopsy Specimens Taken for CP Test: Comparison with Histopathological Analysis. Int J Immunopathol Pharmacol 2016; 17:77-82. [PMID: 15000870 DOI: 10.1177/039463200401700111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aims of the present study were: (i) to assess whether H. pylori could be succesfully detected by PCR from the same biopsy sample used for CPtest; and ii) to evaluate CPtest comparatively to both PCR and histology for detection of H. pylori infection in dyspeptic patients. Three antral gastric biopsies were collected from each of 80 consecutive dyspeptic patients undergoing oesophagogastroduodenoscopy. Two biopsies were for histology (gold standard), one for CPtest, scored at 20min, 1h and 24h for the presence of urease activity. Gastric biopsy was then removed from CPtest and used for ureC-targeted PCR. Fifty-five (68.7%) patients were positive for H. pylori infection by histology. CPtest yielded an overall diagnostic accuracy of 93.8% (95% CI: 91–96.4%), regardless of observation period. No erroneous categorization of H. pylori status occurred using PCR, yielding sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy of 100%. Our results suggest that H. pylori can be detected by PCR in gastric biopsies previously taken for CPtest, so reducing the workload of the endoscopist by saving additional biopsies for culture analysis and susceptibility tests.
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Affiliation(s)
- G Di Bonaventura
- Department of Biomedical Sciences, Clinical Microbiology Laboratory, and Center for Excellence on Aging, G. d'Annunzio University, School of Medicine, Chieti, Italy
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Diagnostic Methods of Helicobacter pylori Infection for Epidemiological Studies: Critical Importance of Indirect Test Validation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4819423. [PMID: 26904678 PMCID: PMC4745376 DOI: 10.1155/2016/4819423] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/16/2015] [Indexed: 01/06/2023]
Abstract
Among the methods developed to detect H. pylori infection, determining the gold standard remains debatable, especially for epidemiological studies. Due to the decreasing sensitivity of direct diagnostic tests (histopathology and/or immunohistochemistry [IHC], rapid urease test [RUT], and culture), several indirect tests, including antibody-based tests (serology and urine test), urea breath test (UBT), and stool antigen test (SAT) have been developed to diagnose H. pylori infection. Among the indirect tests, UBT and SAT became the best methods to determine active infection. While antibody-based tests, especially serology, are widely available and relatively sensitive, their specificity is low. Guidelines indicated that no single test can be considered as the gold standard for the diagnosis of H. pylori infection and that one should consider the method's advantages and disadvantages. Based on four epidemiological studies, culture and RUT present a sensitivity of 74.2–90.8% and 83.3–86.9% and a specificity of 97.7–98.8% and 95.1–97.2%, respectively, when using IHC as a gold standard. The sensitivity of serology is quite high, but that of the urine test was lower compared with that of the other methods. Thus, indirect test validation is important although some commercial kits propose universal cut-off values.
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Krishnaveni D, Amar Chand B, Shravan Kumar P, Uma Devi M, Ramanna M, Jyothy A, Pratibha N, Balakrishna N, Venkateshwari A. Association of endothelial nitric oxide synthase gene T-786C promoter polymorphism with gastric cancer. World J Gastrointest Oncol 2015; 7:87-94. [PMID: 26191352 PMCID: PMC4501928 DOI: 10.4251/wjgo.v7.i7.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/14/2015] [Accepted: 06/02/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the role of endothelial nitric oxide synthase -786T > C promoter polymorphism in the etiology of gastric cancer (GC).
METHODS: A total of 150 GC patients and 150 control subjects were included in the study. The information on demographic features was elicited with an informed consent from all the patients and control subjects using a structured questionnaire. Helicobacter pylori (H. pylori) infectivity status was tested in antral biopsies from all the subjects by rapid urease test following the method of Vaira et al. Genomic DNA was isolated from whole blood samples following the salting out method of Lahiri et al. Genotype analysis of the rs2070744 polymorphism was carried out by allele-specific polymerase chain reaction method. The genotypes were determined based on the appearance of bands on an agarose gel stained with ethidium bromide under ultraviolet gel documentation with the help of 100 bp ladder. Odds ratios and corresponding 95%CIs were determined using java stat online software.
RESULTS: There was a significant difference in the distribution of C allele (C vs T; P = 0.000, OR = 5.038) in patient group compared to the control subjects exhibiting a fivefold increased risk for GC. When the T/T and C/C genotypes were compared, there was an enhanced GC risk for individuals with C/C genotype (T/T vs C/C; P = 0.000). Among the demographic factors, smoking and alcoholism were the common risk factors in patients compared to the control subjects (P < 0.05). Patients with smoking and alcoholism developed cancer even in heterozygous T/C condition (smoking: P = 0.020 and alcoholism: P = 0.005). Individuals with H. pylori infection showed seven fold increased risk for cancer. All the patients with C/C genotype revealed a significant association between H. pylori infection and GC. Among the patients 2.4% of them revealed familial incidence of GC. No significant difference was noticed between cases and controls with regard to consanguinity (P = 0.473).
CONCLUSION: The Present data suggest that eNOS-786 C/C genotype and C allele may be considered as potential risk factors in patients with GC.
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Uotani T, Graham DY. Diagnosis of Helicobacter pylori using the rapid urease test. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:9. [PMID: 25705641 DOI: 10.3978/j.issn.2305-5839.2014.12.04] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/14/2014] [Indexed: 12/13/2022]
Abstract
Helicobacter pylori (H. pylori) is a major human pathogen which causes progressive gastroduodenal damage. Guidelines recommend that, unless there are compelling reasons to delay, treatment is indicated for all patients in whom the infection is diagnosed. The rapid urease test (RUT) is a popular diagnostic test in that it is a rapid, cheap and simple test that detects the presence of urease in or on the gastric mucosa. The sensitivity and specificity are generally high and many versions have been approved for use in humans. Best results are obtained if biopsies are obtained from both the antrum and corpus. The tissue sample embedded in the RUT gel can also be utilized for other tests such as for molecular based tests of microbial susceptibility or for host factors. False-positive results are rare if the RUT contains an antibacterial agent to prevent growth of urease-containing contaminants and the tests are discarded at 24 hours. The use of antimicrobial drugs and proton pump inhibitors as well as the presence of intestinal metaplasia may result in false-negative results. A negative test should not be used as the criteria for cure or in cases where accuracy is important for patient management such as in upper gastrointestinal bleeding. Interpretation of the test should take into account the pretest probability and the prevalence of H. pylori in the population. The test can also be used to provide an informal assessment of the accuracy of the histopathology result and discrepancies should prompt a review of the histopathology and discussions with the pathologist.
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Affiliation(s)
- Takahiro Uotani
- Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, USA
| | - David Y Graham
- Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, USA
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Anand PS, Kamath KP, Anil S. Role of dental plaque, saliva and periodontal disease in Helicobacter pylori infection. World J Gastroenterol 2014; 20:5639-53. [PMID: 24914323 PMCID: PMC4024772 DOI: 10.3748/wjg.v20.i19.5639] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/19/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections in humans. Although H. pylori may be detected in the stomach of approximately half of the world's population, the mechanisms of transmission of the microorganism from individual to individual are not yet clear. Transmission of H. pylori could occur through iatrogenic, fecal-oral, and oral-oral routes, and through food and water. The microorganism may be transmitted orally and has been detected in dental plaque and saliva. However, the role of the oral cavity in the transmission and recurrence of H. pylori infection has been the subject of debate. A large number of studies investigating the role of oral hygiene and periodontal disease in H. pylori infection have varied significantly in terms of their methodology and sample population, resulting in a wide variation in the reported results. Nevertheless, recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H. pylori infection is more likely among patients who harbor the organism in the oral cavity. Furthermore, initial results from clinical trials have shown that H. pylori-positive dyspeptic patients may benefit from periodontal therapy. This paper attempts to review the current body of evidence regarding the role of dental plaque, saliva, and periodontal disease in H. pylori infection.
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Devulapalli K, Bhayal AC, Porike SK, Macherla R, Akka J, Nallari P, Ananthapur V. Role of interstitial collagenase gene promoter polymorphism in the etiology of gastric cancer. Saudi J Gastroenterol 2014; 20:309-14. [PMID: 25253367 PMCID: PMC4196347 DOI: 10.4103/1319-3767.141693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/AIMS Gastric cancer (GC) is a multifactorial disorder mediated by genetic, epigenetic, and environmental risk factors. GC is the most common cancer in India and it is the third prominent cause of cancer death worldwide. A single nucleotide polymorphism (SNP) in the promoter region of interstitial collagenase (MMP-1) gene appears to have an impact on the transcriptional activity and regulation of its expression. Hence, the present study is aimed to evaluate the role of interstitial collagenase gene-1607 1G/2G (rs1799750) promoter polymorphism in the etiology of GC. PATIENTS AND METHODS The study included 166 GC patients and 202 control subjects. Genomic DNA was isolated from whole blood samples of the subjects, and the genotyping of interstitial collagenase promoter polymorphism was carried out by polymerase chain reaction-restriction fragment length polymorphism method followed by agarose gel electrophoresis. Appropriate statistical methods were applied to test the significance of the results. RESULTS The risk factor profile of the patients revealed that male gender, age above 50 years, addiction to alcohol and smoking were the most common risk factors (P < 0.05). There was a significant difference in the distribution of 2G/2G genotype (2G/2G vs. 1G/1G, P = 0.016) and 1G/2G genotype (2G/2G + 1G/2G vs. 1G/1G, P = 0.010) in patient group compared with that of the control subjects. CONCLUSION The present study provides indirect evidence for the role of interstitial collagenase gene 1G/2G promoter polymorphism in the etiology of GC in South Indian population.
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Affiliation(s)
- Krishnaveni Devulapalli
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Andhra Pradesh, India
| | - Amar Chand Bhayal
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Andhra Pradesh, India
| | - Shravan Kumar Porike
- Department of Gastroenterology, Gandhi Hospital, Secunderabad, Andhra Pradesh, India
| | - Ramanna Macherla
- Department of Gastroenterology, Gandhi Hospital, Secunderabad, Andhra Pradesh, India
| | - Jyothy Akka
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Andhra Pradesh, India
| | - Pratibha Nallari
- Department of Genetics, Osmania University, Hyderabad, Andhra Pradesh, India
| | - Venkateshwari Ananthapur
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Andhra Pradesh, India,Address for correspondence: Dr. A. Venkateshwari, Department of Cell Biology, Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad - 500 016, Andhra Pradesh, India. E-mail:
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Krishnaveni D, Bhayal AC, Sri Manjari K, Vidyasagar A, Uma Devi M, Ramanna M, Jyothy A, Nallari P, Venkateshwari A. MMP 9 Gene Promoter Polymorphism in Gastric Cancer. Indian J Clin Biochem 2012; 27:259-64. [PMID: 26405384 DOI: 10.1007/s12291-012-0210-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/26/2012] [Indexed: 12/16/2022]
Abstract
Matrix metalloproteinase-9 (gelatinase B) plays a key role in cancer invasion and metastasis by degrading the extracellular matrix and basement membrane barriers. A cytosine (C) > thymidine (T) single nucleotide polymorphism (SNP) at position -1562 in the MMP-9 promoter is reported to influence the expression of the gene. Genotyping of MMP-9 -1562 C→T promoter polymorphism in 140 gastric cancer patients and 132 healthy control subjects was carried out in order to evaluate its association with progression and development of gastric cancer. The SNP was genotyped by tetra-primer amplification refractory mutation system-polymerase chain reaction followed by agarose gel electrophoresis. Statistical methods were adopted to test for the significance of the results. Risk factor profile of the patients revealed age above 50 years, smoking, alcoholism as the factors associated with the disease. The distribution of genotype frequencies in gastric cancer patients were 28.7 % of CC, 45.5 % of CT and 25.7 % of TT, whereas in control subjects 31.8 % of CC, 53.03 % of CT and 15.15 % of TT, respectively. The allelic frequencies were 51.51 % of C and 48.48 % of T in patient group and 58.33 % of C and 41.66 % of T in controls respectively. The present study shows the possible association of epidemiological risk factors with gastric cancer. There is an increased frequency of T allele in the disease compared to control subjects. However, there is no association of the MMP-9 -1562 C→T promoter polymorphism in the development of gastric cancer.
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Affiliation(s)
- D Krishnaveni
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500 016 India
| | - Amar Chand Bhayal
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500 016 India
| | - K Sri Manjari
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500 016 India
| | - A Vidyasagar
- Department of Gastroenterology, Gandhi Hospital, Hyderabad, 500 003 India
| | - M Uma Devi
- Department of Gastroenterology, Gandhi Hospital, Hyderabad, 500 003 India
| | - M Ramanna
- Department of Gastroenterology, Gandhi Hospital, Hyderabad, 500 003 India
| | - A Jyothy
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500 016 India
| | - Pratibha Nallari
- Department of Genetics, Osmania University, Hyderabad, 500 007 India
| | - A Venkateshwari
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500 016 India
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Osaki T, Mabe K, Hanawa T, Kamiya S. Urease-positive bacteria in the stomach induce a false-positive reaction in a urea breath test for diagnosis of Helicobacter pylori infection. J Med Microbiol 2008; 57:814-819. [PMID: 18566138 DOI: 10.1099/jmm.0.47768-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study investigated the influence of urease-positive non-Helicobacter pylori bacteria on the results of a urea breath test (UBT) to evaluate the diagnostic utility of a UBT using film-coated [(13)C]urea tablets. The UBT was performed in 102 patients treated with a proton pump inhibitor and antibiotics for the eradication of H. pylori. Urease-producing bacteria other than H. pylori were isolated and identified from the oral cavity and stomach. In 4/102 patients, the UBT gave false-positive results. These false-positive results were found to be caused by the presence of urease-positive bacteria in the oral cavity and stomach. Five bacterial species with urease activity (Proteus mirabilis, Citrobacter freundii, Klebsiella pneumoniae, Enterobacter cloacae and Staphylococcus aureus) were subsequently isolated from the oral cavity and/or stomach. As there was no correlation between the in vitro urease activity of urease-positive non-H. pylori bacteria and the UBT value, and all of the patients with a false-positive UBT result were suffering from atrophic gastritis, it is possible that the false-positive results in the UBT were a result of colonization of urease-positive bacteria and gastric hypochlorhydric conditions. Thus, for the diagnosis of H. pylori infection using a UBT, the influence of stomach bacteria must be considered when interpreting the results.
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Affiliation(s)
- Takako Osaki
- Department of Infectious Diseases, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Katsuhiro Mabe
- Department of Internal Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Tomoko Hanawa
- Department of Infectious Diseases, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shigeru Kamiya
- Department of Infectious Diseases, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Anand PS, Nandakumar K, Shenoy KT. Are Dental Plaque, Poor Oral Hygiene, and Periodontal Disease Associated WithHelicobacter pyloriInfection? J Periodontol 2006; 77:692-8. [PMID: 16584352 DOI: 10.1902/jop.2006.050163] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The microorganism Helicobacter pylori has been closely linked to chronic gastritis, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma. Despite the current treatment regimens that lead to successful management of H. pylori-positive chronic gastritis, the reinfection rate is high. It has been suggested that one of the possible mechanisms of reinfection is the recolonization from dental plaque. The purpose of this study was to determine whether dental plaque, poor oral hygiene, and periodontal disease were risk factors for H. pylori infection. METHODS Among the 134 patients, 65 patients who had a positive H. pylori serology or positive rapid urease test or histologic evidence for the presence of H. pylori in antral biopsy specimens were categorized as cases. The remaining 69 patients who were negative for H. pylori serology, the rapid urease test, and histology were controls. RESULTS It was found that the association of periodontal disease and poor oral hygiene with H. pylori infection was not significant. There was a higher prevalence of H. pylori in the dental plaque of patients with gastric H. pylori infection than in controls, but both groups had a surprisingly high positive urease test for H. pylori in plaque (89% and 71%, respectively). CONCLUSIONS H. pylori in dental plaque is seldom eliminated by H. pylori-eradication therapy, and this may act as a source for future reinfection. Hence, eradication of H. pylori from the dental plaque should be made an important part of comprehensive management of H. pylori-associated gastric diseases.
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Affiliation(s)
- Pradeep S Anand
- Department of Periodontics, Government Dental College, Trivandrum, Kerala, India.
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Gürbüz AK, Ozel AM, Yazgan Y, Celik M, Yildirim S. Oral colonization of Helicobacter pylori: risk factors and response to eradication therapy. South Med J 2003; 96:244-7. [PMID: 12659355 DOI: 10.1097/01.smj.0000051069.50950.2b] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dental plaque is considered by some to be a secondary reservoir for Helicobacter pylori and thus responsible for gastric reinfection. The aim of this study was to investigate whether testing dental plaque using a rapid urease test (CLOtest) can be used to determine gastric H. pylori status. METHODS We investigated dental plaque colonization by H. pylori and its correlation with gastric infection in 75 dyspeptic patients. CLOtest was used to determine H. pylori positivity. RESULTS Tests for H. pylori were positive in dental plaque samples from 68 patients and in stomach samples from 65 patients. The sensitivity of using CLOtest in dental plaque to determine gastric H. pylori status was 89.7%, with a diagnostic accuracy of 86.7%. Gastric eradication was achieved in 83% of patients, but efforts to eradicate dental plaque colonization were unsuccessful in all patients. CONCLUSION Using CLOtest to detect H. pylori in dental plaque is a reliable first-line diagnostic approach for gastric H. pylori infection. Dental plaque might be a sanctuary for H. pylori, leading to gastric recurrence.
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Affiliation(s)
- Ahmet Kemal Gürbüz
- Department of Gastroenterology, Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
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Madani S, Rabah R, Tolia V. Diagnosis of Helicobacter pylori infection from antral biopsies in pediatric patients is urease test that reliable? Dig Dis Sci 2000; 45:1233-7. [PMID: 10877242 DOI: 10.1023/a:1005574608074] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Our objectives were to determine if the urease (CLO) test alone is a reliable diagnostic test for H. pylori gastritis in children and if the density of H. pylori influences the CLO test result. We performed a combined retrospective and prospective study reviewing the results of CLO-test and histology of gastric mucosal biopsy from 67 patients (35 females) with H. pylori gastritis. Two antral biopsies were inoculated on the CLO-test and two processed for histology to grade the severity of gastritis and H. pylori density. The mean age of patients was 11 years (SD +/- 4.53). Only 50 patients tested positive for H. pylori on CLO-test, whereas all patients were positive on histology. The sensitivity of the CLO-test was 75%. There was a significant association between CLO-test positivity and the density of H. pylori organisms on histology (P < 0.01), and with the severity of gastritis (P < 0.001) by the Pearson chi-square test. However, there was no association between the density of H. pylori and severity of gastritis. In conclusion, the CLO-test is not reliable as a sole diagnostic test for H. pylori gastritis in children because of a significant number of false negatives. Histologic examination of gastric mucosal biopsy is superior to the CLO-test in diagnosing H. pylori infection.
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Affiliation(s)
- S Madani
- Department of Pediatric Pathology, Children's Hospital of Michigan, Detroit, USA
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Affiliation(s)
- T U Westblom
- Department of Internal Medicine, College of Medicine, Texas A&M University, Central Texas Veterans Health Care System, Temple, USA
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Abstract
In view of its potential risk for the development of gastrointestinal disease or even gastric cancer at a later age, the study of Helicobacter pylori infection in childhood is gaining increasing importance and H. pylori infection is being considered a major issue of public health. H. pylori infection can be detected by a variety of methods. Because of its easy use, affordability, and overall availability, serology is the preferred diagnostic test, especially for large epidemiological studies. Based on our results, one might consider treating a child with recurrent abdominal pain and positive serology for H. pylori without further work-up, and only perform additional investigations when an anti-H. pylori therapy fails to resolve the complaints. According to this proposition, endoscopy of the upper gastrointestinal tract remains indicated in children if the noninvasive tests for Helicobacter pylori are negative in the absence of a diagnosis, or if symptomatology persists despite treatment.
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Affiliation(s)
- U Blecker
- Division of Pediatric Gastroenterology, Louisiana State University Medical Center, New Orleans 70112, USA
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Persico M, Suozzo R, De Seta M, Montella F, Torella R, Gentile S. Non-ulcer dyspepsia and Helicobacter pylori in type 2 diabetic patients: association with autonomic neuropathy. Diabetes Res Clin Pract 1996; 31:87-92. [PMID: 8792106 DOI: 10.1016/0168-8227(96)01207-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Diabetic patients often suffer from symptoms arising from the gastrointestinal tract. Several factors are considered responsible for these alterations, including abnormalities of gastric motility. Recently Helicobacter pylori (HP) has been identified in a relevant aliquot of subjects with or without gastrointestinal abnormalities, but only scarce and controversial data are available on the prevalence of HP and the association between HP and chronic gastritis or peptic ulcer in diabetic patients. In addition, the possible association between alterations of gastric motility induced by autonomic neuropathy (AN) and the presence of HP has never been evaluated in diabetic subjects. In this study we document the presence of HP in the gastric biopsies of 73% out of a series of 29 patients affected by type 2 diabetes and non-ulcer dyspepsia (3 with oesophagitis, 10 with gastritis, 7 with bulbar duodenitis, and 9 with a normal endoscopy), with a significantly higher prevalence (P < 0.01) in subjects with AN (74%) than in subjects without AN (26%). Two other tests have been compared with the histological evidence of HP (used as golden standard), i.e. the urease test (CP-test) and the assay of anti-HP G-immunoglobulins, both of which were positive in a significantly (P < 0.01) higher percentage of neuropathic patients in comparison with non-neuropathic patients. The sensitivity and the specificity of the CP-test were 96% and 100%, respectively. Similarly, both the sensitivity and the specificity of the assay of IgG HP-Ab were 100%. Since patients affected by non-ulcer dyspepsia and NIDDM complicated by autonomic neuropathy are under a higher risk to be carriers of HP than non-neuropathic or non-diabetic patients. The assay of serum IgG HP-Ab could be used as a screening method, thus avoiding the more expensive and time-consuming endoscopy.
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Affiliation(s)
- M Persico
- Institute of Internal Medicine and Clinical Methodology, Medical School, 2nd University of Naples, Italy
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17
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Xia HY, Keane CT, O'Morain CA. Eradication rate of Helicobcter pylori. Gut 1995; 37:591-2. [PMID: 7489957 PMCID: PMC1382925 DOI: 10.1136/gut.37.4.591-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Abstract
Patients with chronic dyspepsia were categorised by macroscopic appearance at oesophagogastroduodenoscopy as having duodenal ulceration (DU), other diagnosed lesions such as reflux oesophagitis, carcinoma of stomach, etc, or no organic lesion (non-ulcer dyspepsia, NUD). Material was collected to identify gastric infection with Helicobacter pylori (H pylori) by CP urease test, culture, and histological examination and to make the microscopic diagnosis of active chronic gastritis. Each patient in the DU and NUD categories was then invited to volunteer for a gastric secretion study in which maximal gastric secretion in response to histamine was measured. Sixty two gastric secretion tests were performed (31 DU, 31 NUD). The presence of H pylori was associated with active chronic gastritis (100%). DU patients secreted more acid than the NUD patients. H pylori positivity was associated with decreased maximal gastric secretion in both groups. There was a positive correlation between smoking and maximal acid output shown only in H pylori negative but not in H pylori positive patients. These findings were clear cut when all corrections of maximal gastric secretion were made for pyloric loss, duodenogastric reflux, and stature. This study failed to show any aetiological link between H pylori and DU by increased maximal gastric secretion.
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19
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Lee N, Lee TT, Fang KM. Assessment of four rapid urease test systems for detection of Helicobacter pylori in gastric biopsy specimens. Diagn Microbiol Infect Dis 1994; 18:69-74. [PMID: 8062534 DOI: 10.1016/0732-8893(94)90067-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An in vitro experiment and an in vivo clinical trial were both performed in order to assess the efficacy of four biopsy urease test systems, including one commercial kit, Temmler CUT test (Temmler Pharma, Marburg, Germany), for the rapid detection of Helicobacter pylori. We first evaluated four rapid urease test systems by inoculating bacterial suspensions of different concentrations into urea-containing media and observing the color change at room temperature. We found that the CUT test was superior in vitro to the other three urease test systems. As was expected, the lower the concentration of the inoculum, the slower was the color change and the fewer were the positive results noted. The minimal concentration of H. pylori for a positive urease test at 24 h was 1000-10,000 colony-forming units/ml in 1 drop of bacterial suspension inoculated. We then evaluated four biopsy urease test systems for the rapid diagnosis of H. pylori infection in antral and fundal mucosa biopsy specimens of 37 patients undergoing upper gastrointestinal endoscopy. All four test systems were 100% specific when compared with culture. In 69 culture-positive biopsy specimens, the CUT test was not only more sensitive (72%) than the other three systems (42%, 51%, and 45%, respectively), but also gave the fastest reaction by detecting more culture-positive biopsy specimens after 3 h of incubation at room temperature. The differences were statistically significant.
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Affiliation(s)
- N Lee
- Department of Pathology and Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
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20
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Misra SP, Dwivedi M, Misra V, Gupta SC. Imprint cytology--a cheap, rapid and effective method for diagnosing Helicobacter pylori. Postgrad Med J 1993; 69:291-5. [PMID: 8321793 PMCID: PMC2399649 DOI: 10.1136/pgmj.69.810.291] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To compare the efficacy of imprint cytology, histology and CLO-test (for biopsy urease) in detecting Helicobacter pylori infection, antral biopsies were taken from 239 patients undergoing upper gastrointestinal endoscopy. Both imprint cytology and histology showed the presence of H. pylori in 215 (90%) patients. The sensitivity and specificity of imprint cytology vis-à-vis histology was noted to be 100%. The CLO-test was performed in 165 patients and was positive in 130 (79%) patients. The sensitivity and specificity of the CLO-test were 89% and 95%, respectively. The median time required for the CLO-test to become positive and for imprint was 60 minutes for each. The sensitivity of the CLO-test was reduced further in patients receiving colloidal bismuth subcitrate. Of the 27 patients receiving the drug the sensitivity of the CLO-test was only 9% after 4 weeks of therapy. However, the specificity was 100%. The sensitivity and specificity of imprint cytology were unaffected by the antimicrobial therapy and after 4 weeks of treatment were still 100%. It is concluded that the CLO-test has a lower sensitivity and specificity for diagnosing H. pylori infection compared to imprint cytology, which had a sensitivity and specificity equal to that of histology. Imprint cytology may be prepared as an adjunct to histology in patients in whom antral biopsies are taken as it offers a relatively quick diagnosis of H. pylori infection, is considerably cheaper than the CLO-test and does not require additional biopsy material.
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Affiliation(s)
- S P Misra
- Department of Gastroenterology, M.L.N. Medical College, Allahabad, India
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21
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Ahmed A, Holton J, Vaira D, Smith SK, Hoult JR. Eicosanoid synthesis and Helicobacter pylori associated gastritis: increase in leukotriene C4 generation associated with H. pylori colonization. PROSTAGLANDINS 1992; 44:75-86. [PMID: 1641505 DOI: 10.1016/0090-6980(92)90109-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The importance of pro-inflammatory leukotriene C4 in Helicobacter pylori (H. pylori) associated gastritis in man is unknown. Fresh gastric biopsy specimens from 28 dyspeptic patients were obtained: 10 showed normal antral histology with no evidence of H. pylori, the remaining 18 patients exhibited histological gastritis and were H. pylori positive as assessed by histology, culture and urease test. Twelve of these 18 patients received 240 mg twice daily colloidal bismuth subcitrate for four weeks before re-endoscopy. Gastric biopsies from H. pylori positive patients were incubated under basal and Ca(2+)-ionophore mediated conditions: Radioimmunoassay analysis of the supernatant showed basal release of prostaglandin E2 and leukotriene C4 was slightly but not significantly elevated in H. pylori positive mucosa. However in H. pylori positive mucosa there was an 85% increase in leukotriene C4 synthesis when biopsies were incubated with ionophore, compared to only 13% increase in H. pylori negative mucosa (p less than 0.02). After eradication of H. pylori by colloidal bismuth subcitrate, there was a clearance of inflammatory cell infiltrate as assessed by histology and a significant reduction in ionophore-mediated leukotriene C4 formation compared with before treatment (p less than 0.02). These results suggest that H. pylori gastritis is associated with increased capacity to generate leukotriene C4, which may amplify the damaging effects of the bacteria on gastric mucosa.
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Affiliation(s)
- A Ahmed
- Department of Surgery and Microbiology, Middlesex Hospital, London, U.K
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22
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Harries AD, Stewart M, Deegan KM, Mughogho GK, Wirima JJ, Hommel M, Hart CA. Helicobacter pyrlori in Malawi, central Africa. J Infect 1992; 24:269-76. [PMID: 1602148 DOI: 10.1016/s0163-4453(05)80032-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A total of 160 adult Malawians with epigastric pain for longer than 2 weeks was investigated by endoscopy and serologically for evidence of infection with Helicobacter pylori. The organism was demonstrated histologically and/or by culture in 141 (88%) patients. With histological means and/or culture as the 'gold standard', the histological technique was 100% sensitive while culture was only 81% sensitive. All isolates tested were sensitive to amoxycillin and tetracycline; 74% were resistant to metronidazole. Endoscopic findings were normal in 104 (65%) patients (86.5% H. pylori positive). Evidence of duodenal ulcer was found in 41 (25%) patients (95% H. pylori positive). Histologically, gastritis was common, severe gastritis being associated with increased colonisation by H. pylori. Two kinds of urease test were found to be 100% specific for the presence of H. pylori. The sensitivity of the serological test (Helico-G test) was 98% but its specificity was only 27%. These results provide important background information for planned therapeutic studies in patients with upper gastro-intestinal disease in Malawi.
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23
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Halter F, Hurlimann S, Inauen W. Pathophysiology and clinical relevance of Helicobacter pylori. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 1992; 65:625-38. [PMID: 1341068 PMCID: PMC2589759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Considerable knowledge has recently accumulated on the mechanism by which Helicobacter pylori (H. pylori) induces chronic gastritis. Although H. pylori is not an invasive bacterium, soluble surface constituents can provoke pepsinogen release from gastric chief cells or trigger local inflammation in the underlying tissue. Urease appears to be one of the prime chemoattractants for recruitment and activation of inflammatory cells. Release of cytokines, such as tumor necrosis factor alpha, interleukin 1 and 6, and oxygen radicals, leads to a further tissue inflammation accompanied by a potent systemic IgA and IgG type of immune response. Chronic inflammation and antigens on glandular epithelial cells lead to a progressive destruction with loss of the epithelial barrier function. Within the gastric mucosa, patches of intestinal metaplasia develop, which may be a risk factor for subsequent development of gastric carcinoma. Hyperacidity in duodenal ulcer patients induces gastric metaplasia in the duodenal bulb, which represents a target for H. pylori colonization and ulcer formation. H. pylori can be detected in the majority of patients with peptic ulcers and, compared to age-matched healthy people, it is also found more often in patients with dyspepsia and gastric carcinoma. Although H. pylori can be detected in healthy people, the marked reduction of the ulcer recurrence rate by eradication of H. pylori (80 percent versus 20 percent relapse within one year) suggests that H. pylori is a major risk factor for duodenal ulcer formation. The potential role of H. pylori in non-ulcer dyspepsia and carcinogenesis is under investigation. Current regimens aimed at eradicating H. pylori use a combination of several drugs that are potentially toxic. Since the risk of complications may exceed the potential benefit in most patients, eradication treatment should be limited to clinical trials and to patients with aggressive ulcer disease. New drug regimens, e.g., the combination of proton pump inhibitors with one antibiotic, may provide less toxic alternatives. Beyond ulcer treatment, effective and well-tolerated eradication regimens may have a place in prophylaxis of gastric carcinoma.
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Affiliation(s)
- F Halter
- Gastrointestinal Unit, University Hospital, Inselspital, Bern, Switzerland
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24
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Desai HG, Gill HH, Shankaran K, Mehta PR, Prabhu SR. Dental plaque: a permanent reservoir of Helicobacter pylori? Scand J Gastroenterol 1991; 26:1205-8. [PMID: 1754858 DOI: 10.3109/00365529108998615] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of the study was to observe the relationship between the two reservoirs of Helicobacter pylori--that is, dental plaque and the stomach. With the Campylobacter-like organism (CLO) test, H. pylori was detected in dental plaque and in gastric antral and body mucosa in 98%, 67% and 70%, respectively, of 43 consecutive patients with dyspepsia. The rapidity of the CLO test indicates that the density of H. pylori is heaviest in dental plaque, less in the antrum, and least in the body mucosa of the stomach. Triple drug therapy (bismuth, tinidazole, and amoxycillin or doxycycline) was administered for 15 days to 24 patients. By the CLO test, H. pylori was eliminated from the gastric mucosa in all 24 patients but persisted in dental plaque in all of them. Our observations indicate that dental plaque is unaffected by triple drug therapy and is perhaps a permanent reservoir of H. pylori if local therapy also fails to eradicate the organism.
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Affiliation(s)
- H G Desai
- Dept. of Gastroenterology, B.Y.L. Nair Charitable Hospital, Bombay, India
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25
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Thillainayagam AV, Arvind AS, Cook RS, Harrison IG, Tabaqchali S, Farthing MJ. Diagnostic efficiency of an ultrarapid endoscopy room test for Helicobacter pylori. Gut 1991; 32:467-9. [PMID: 2040465 PMCID: PMC1378917 DOI: 10.1136/gut.32.5.467] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There are several reliable methods for detecting Helicobacter pylori but all have as a major disadvantage the time required to yield a definitive result. We have modified the standard urease test so that a positive result is available in one minute. We describe the use of this test in biopsy specimens from the gastric antrum from 220 consecutive patients referred for upper gastrointestinal endoscopy. The performance of the 'one minute test' was compared with a standard urease test, Gram stain, and microbiological culture. Using culture as the 'gold standard' 80 (36%) of the patients were H pylori positive. The one minute test produced no false positives and showed a sensitivity of 89% and specificity of 100%, while the predictive values of a positive and negative test were 100% and 94% respectively. The diagnostic efficiency of the test was 96% compared to 85% for both the Gram stain and direct urease test. All positive results using the one minute test were available within one minute. The test is easy to prepare and costs approximately pounds 0.04. This new modification of the urease test should be superior to the currently available urease tests because a reliable result will be available in almost 90% of infected individuals even before endoscopy is completed.
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Affiliation(s)
- A V Thillainayagam
- Department of Gastroenterology, St Bartholomew's Hospital, West Smithfield, London
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26
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Vogt K, Hahn H. Urease production by Helicobacter (Campylobacter) pylori. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1991; 275:63-72. [PMID: 1930566 DOI: 10.1016/s0934-8840(11)80768-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Urease activity of 50 Helicobacter pylori (H. pylori) strains was assessed employing a photometric assay. Urea hydrolysis reached a maximum in the late log-phase and during the plateau phase of bacterial growth. The reaction time of H. pylori urease was significantly shorter than that of other urease producing bacteria (P. mirabilis, P. vulgaris, K. pneumoniae, K. oxytoca). Increasing the reaction temperature hardly led to an acceleration of the quick urea hydrolysis of H. pylori, in contrast to the situation with P. mirabilis. Acetohydroxamic acid showed a dose-dependent non-competitive suppression of urease production, whereas 9 antibiotics in subinhibitory concentrations did not influence urease production of H. pylori.
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Affiliation(s)
- K Vogt
- Institut für Medizinische Mikrobiologie und Infektionsimmunologie, Freien Universität, Berlin
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27
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Hernández F, Rivera P, Sigarán M, Miranda J. Diagnosis of Helicobacter pylori: comparison of an urease test, histological visualization of curved bacteria and culture. Rev Inst Med Trop Sao Paulo 1991; 33:80-2. [PMID: 1843403 DOI: 10.1590/s0036-46651991000100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Helicobacter pylori was investigated in 189 patients for culture, microscopic visualization of campylobacter-like organisms (CLO) and a ten minute urease test. In 136 (72%) the bacteria was isolated, and in 98 of them CLO were histologically detected. Specificity, sensitivity, positive and negative predictive values of microscopic visualization of CLO were: 0.77, 0.73, 0.97 and 0.51, respectively; 98 culture-positive patients were urease test positive. Specificity, sensitivity, positive and negative predictive values of the urease test were: 0.83, 0.72, 0.92 and 0.54, respectively. Comparing the urease test with culture of H. pylori combined with microscopic visualization of CLO, its specificity, sensitivity, positive and negative predictive values were: 0.95, 0.71, 0.98 and 0.48, respectively. Probably, these values are not real, since bacteria different from H. pylori could be misclassified as CLO.
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Affiliation(s)
- F Hernández
- Centro de Investigación y Diagnóstico en Parasitología, Facultad de Microbiología Universidad de Costa Rica, San José
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28
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29
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Bhasin DK, Ayyagiri A, Singh V, Mehta SK. Rapid urease tests for Campylobacter pylori. J Clin Pathol 1990; 43:174. [PMID: 2180988 PMCID: PMC502312 DOI: 10.1136/jcp.43.2.174-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Callewaert E. Peliosis thymomis. Clin Mol Pathol 1990; 43:174. [PMID: 16811179 PMCID: PMC502311 DOI: 10.1136/jcp.43.2.174-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E Callewaert
- Algemeen Ziekenhuis St Lucas-St Jozef 8320 Brugge 4, Belgium
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31
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McNulty CA, Dent JC, Uff JS, Gear MW, Wilkinson SP. Detection of Campylobacter pylori by the biopsy urease test: an assessment in 1445 patients. Gut 1989; 30:1058-62. [PMID: 2767501 PMCID: PMC1434183 DOI: 10.1136/gut.30.8.1058] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The presence of C pylori infection was determined in 1445 patients undergoing upper gastrointestinal endoscopy over a 12 month period. The presence of C pylori was detected in gastric mucosal biopsy specimens by the biopsy urease test, microscopy (Gram stained smears and histology) and culture. Two media were used for the biopsy urease test: Christensen's urea broth (for the first 600 patients) and the Christensen's urea broth modified by increasing the concentration of phenol red and omitting the nutrients, glucose and peptone (for the remaining patients). Both the Christensen's urea broth and modified urea broth were almost 100% specific when compared with detection of C pylori by Gram, culture and histopathology. The modified broth was more sensitive (96% sensitivity compared with culture) than the Christensen's broth (92% sensitivity) but this difference was not statistically significant. The modified broth gave significantly more positive results (58%) in less than 30 minutes than the Christensen's broth (48%). Seventy four per cent of positive results were available in less than two hours. Specimens from patients with extensive C pylori infection gave more rapid results: 86% of specimens that yielded a profuse growth of C pylori and 76% that contained numerous organisms on histological sections had a positive urease test in less than one hour. There was no significant difference between the specificity and sensitivity of our modified urea broth and the other modified broths described in the literature. This test is a cheap and rapid alternative to the diagnosis of C pylori by Gram stained smears or culture.
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Affiliation(s)
- C A McNulty
- Public Health Laboratory, Gloucestershire Royal Hospital
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32
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Vaira D, Holton J, Osborn J, Dowsett J, McNeil I, Hatfield A. Use of endoscopy in patients with dyspepsia. BMJ (CLINICAL RESEARCH ED.) 1989; 299:237. [PMID: 2504380 PMCID: PMC1836956 DOI: 10.1136/bmj.299.6693.237] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D Vaira
- Department of Gastroenterology and Microbiology, Middlesex Hospital, London
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33
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Bhasin D, Yachha S, Ayyagiri A, Singh V, Kochhar R, Malik A, Mehta S. How specific is the rapid urease test for diagnosing Campylobacter pylori? J Clin Pathol 1989; 42:671. [PMID: 2661596 PMCID: PMC1142006 DOI: 10.1136/jcp.42.6.671-a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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34
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Vaira D, Holton J, Ainley CC, Lonedi M, Romanos A, Maldini M, Gandolfi L. The source of Campylobacter pylori. Biomed Pharmacother 1989; 43:447-50. [PMID: 2590720 DOI: 10.1016/0753-3322(89)90244-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sera from 98 abattoir workers were tested for IgG as well as for IgA to Campylobacter pylori, C. jejuni and Klebsiella. Clerical workers had significantly lower C. pylori and C. jejuni antibody levels than any of the groups in direct contact with freshly cut animal parts. No difference was found for antibodies to Klebsiella. Twenty-nine non-clerical workers with high IgG antibody levels against C. pylori consented to upper gastrointestinal endoscopy. C. pylori associated gastritis was found in all 29, and 4 weeks of colloidal bismuth subcitrate (240 mg/twice daily) was prescribed. On repeat testing at 3 months, all showed a decrease in IgG antibody levels to C. pylori but not to C. jejuni, whereas 18 untreated non-endoscoped workers showed no change. These findings raise the possibility that C. pylori infection is a zoonosis.
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Affiliation(s)
- D Vaira
- Department of Gastroenterology, Middlesex Hospital, London, U.K
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35
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Vaira D, D'Anastasio C, Holton J, Dowsett JF, Londei M, Bertoni F, Beltrandi E, Grauenfels P, Salmon PR, Gandolfi L. Campylobacter pylori in abattoir workers: is it a zoonosis? Lancet 1988; 2:725-6. [PMID: 2901576 DOI: 10.1016/s0140-6736(88)90196-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sera from 98 abattoir workers were tested for IgG to Campylobacter pylori, C jejuni, and klebsiella. Clerical workers had significantly lower C pylori and C jejuni IgG titres than any of the groups in direct contact with freshly cut animal parts. No difference was found for antibodies to klebsiella. 28 non-clerical workers with high-titre C pylori IgG consented to upper gastrointestinal endoscopy. C pylori associated gastritis was found in all 28, and four weeks of colloidal bismuth subcitrate (240 mg twice daily) was prescribed. On repeat testing at three months all showed a decrease in IgG titres to C pylori but not to C jejuni, whereas 18 untreated non-endoscoped workers showed no change. These findings raise the possibility that C pylori infection is a zoonosis.
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Affiliation(s)
- D Vaira
- Department of Gastroenterology, Middlesex Hospital, London, UK
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36
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Vaira D, Holton J, Cairns SR, Falzon M, Polydorou A, Dowsett JF, Salmon PR. Antibody titres to Campylobacter pylori after treatment for gastritis. BMJ (CLINICAL RESEARCH ED.) 1988; 297:397. [PMID: 3408982 PMCID: PMC1834287 DOI: 10.1136/bmj.297.6645.397] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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