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Helicobacter pylori Noninvasive Testing

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141. Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon

‘‘specialized intestinal metaplasia.’’ In the stomach, intestinal metaplasia is associated with chronic gastritis and Helicobacter pyloriinfection.Inbothsitestherealso canbepancreaticmetaplasia. Adenoma and dysplasia In Western countries, a noninvasive neoplastic and benign lesion of the columnar epithelium is calledan‘‘adenoma’’whenprotruding(polypoid)and a ‘‘dysplasia’’ when ?at or depressed (non-polyp- oid), 18-20 although the terms ‘‘?at adenoma’’ and ‘‘depressed adenoma’’ are accepted and commonly used (...) not require treatmentfromneoplasticlesions. Interpretation of the surface pit pattern with magni?cation is easier in the large bowel than in the stomach because of gastric in?ammation associ- ated with the high prevalence of H pylori in many populations. In the large bowel mucosa, distinct typesofpitpatternshavebeendescribedfornormal mucosaandfornon-neoplasticandneoplasticlesions (low-grade or high-grade intraepithelial neoplasia). Incarcinoma,thesurfacepatterniseitherirregular or amorphous. In addition

2002 World Endoscopy Organization

142. Do patients with pernicious anaemia and confirmed atrophic gastritis require further regular upper GI endoscopies in view of the risk of stomach cancer?

regular upper GI endoscopies in view of the risk of stomach cancer? We searched TRIP, Medline and the NLH and found no guidelines on this topic. eMedicine (an American publication) has a chapter on atrophic gastritis [1] which includes a section on further outpatient care, which states: “Guidelines for follow-up care for cases of atrophic gastritis are not established. If the patient was treated for H pylori infection, confirm eradication. Perform evaluation of eradication at least 4 weeks after (...) the end of treatment. Eradication may be assessed by noninvasive methods, such as the urea breath test. Follow-up care may be individualized depending on findings during endoscopy. For example, if dysplasia is found at endoscopy, increased surveillance is necessary.” Given the lack of clear guidance we recommend you discuss this with your local trust who may well have a local protocol on this topic. Reference 1) Answered 16 July 2007 Follow us: © 2019 Trip Database Ltd. company number 04316414. Trip

2007 TRIP Answers

143. Serum ghrelin as a marker of atrophic body gastritis in patients with parietal cell antibodies. Full Text available with Trip Pro

and 211 control subjects. All patients and control subjects were screened for circulating parietal cell antibodies (PCAs) and were tested for serum ghrelin, gastrin, pepsinogen I and II, and anti-Helicobacter pylori antibody levels. A total of 52 patients and 28 control subjects underwent a gastric endoscopy.In PCA/positive patients, mean (+/-sd) serum ghrelin levels were significantly lower (238 +/- 107 pmol/liter), and mean (+/-sd) serum gastrin levels were significantly higher (81.2 +/- 128.3 ng/ml (...) %, respectively) in detecting gastric atrophy and was superior to gastrin (P = 0.012), PCA (P = 0.002), and the pepsinogen I/II ratio (P = 0.016) measurements.Our study demonstrates that ghrelin secretion is negatively affected by autoimmune gastritis, and its serum level represents the most sensitive and specific noninvasive marker for selecting patients at high risk for ABG.

2007 Journal of Clinical Endocrinology and Metabolism

144. Guidelines for the management of dyspepsia. (Abstract)

equivalent options: (i) test and treat for Helicobacter pylori (H. pylori) using a validated noninvasive test and a trial of acid suppression if eradication is successful but symptoms do not resolve or (ii) an empiric trial of acid suppression with a proton pump inhibitor (PPI) for 4-8 wk. The test-and-treat option is preferable in populations with a moderate to high prevalence of H. pylori infection (> or =10%); empirical PPI is an initial option in low prevalence situations. If initial acid suppression (...) . In patients who do respond to initial therapy, stop treatment after 4-8 wk; if symptoms recur, another course of the same treatment is justified. The management of functional dyspepsia is challenging when initial antisecretory therapy and H. pylori eradication fails. There are very limited data to support the use of low-dose tricyclic antidepressants or psychological treatments in functional dyspepsia.

2005 American Journal of Gastroenterology

145. Evaluation of initial noninvasive therapy in pediatric patients presenting with suspected ulcer disease

on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The following treatment strategies in the treatment of children with dyspepsia were compared: (1) Immediate endoscopy (EGD) with biopsy for Helicobacter pylori (H. pylori) infection; (2) immediate EGD without biopsy; (3) H. pylori serology and treatment for H. pylori if serology (...) disease, rate of H. pylori infection if ulcer, rate of H. pylori infection if no ulcer, ulcer healing rate after antisecretory therapy, H. pylori infection eradication after antibiotics (including compliance), symptoms if ulcer persists after antisecretory therapy, symptoms if ulcer healed after antisecretory therapy, H.pylori serologic test sensitivity and specificity. Study designs and other criteria for inclusion in the review One prospective double-blind study was reported. No more details were

1996 NHS Economic Evaluation Database.

146. A Test of Iron Malabsorption in Patients With Iron Deficiency Anemia

provided by: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Study Details Study Description Go to Brief Summary: The objective of the study is to develop a simple, noninvasive test for evaluation of iron absorption as a tool to determine the cause of iron deficiency anemia. Healthy, premenopausal women with iron deficiency with or without anemia will be recruited for the study. Participants will, over the course of two months, ingest an iron solution three times; after each (...) A Test of Iron Malabsorption in Patients With Iron Deficiency Anemia A Test of Iron Malabsorption in Patients With Iron Deficiency Anemia - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. A Test of Iron

2006 Clinical Trials

147. Cost-effectiveness of noninvasive testing and treatment strategies for H.pylori infection in children with dyspepsia

-effectiveness of noninvasive testing and treatment strategies for H.pylori infection in children with dyspepsia. American Journal of Gastroenterology 1998; 93(4): 562-568 PubMedID DOI Other publications of related interest 1. Briggs A H, Sculpher M J, Logan R P H, Aldous J, Ramsay M E, Baron J H. Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age. BMJ 1996;312:1321-1325. 2. McIntyre A M, MacGregor S, Malek M, Dunbar J (...) abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Noninvasive testing and treatment strategies for Helicobacter pylori infection. Type of intervention Screening and treatment. Economic study type Cost-effectiveness analysis. Study population Hypothetical population of 1,000 children with dyspepsia. Setting Primary and secondary care. The study was carried

1998 NHS Economic Evaluation Database.

148. Helicobacter and disease: still more questions than answers Full Text available with Trip Pro

Helicobacter and disease: still more questions than answers Since the causative role of Helicobacter pylori in peptic ulcer and gastritis was established, a number of advances have been made. Helicobacter virulence factors have been identified, the changes it causes in gastric acid secretion has been elucidated, and the entire genome of H. pylori has been mapped. Multiple lines of evidence indicate a strong link between the bacterium and noncardia gastric cancer. The infection can (...) be confidently diagnosed by noninvasive serologic tests and the urea breath test. Triple therapy is almost always curative, and the infection almost never recurs in Canadian adults, but eradicating the bacteria in the absence of peptic ulcer only rarely leads to resolution of dyspepsia. New studies suggest that treating Helicobacter may increase the risk of peptic esophagitis and adenocarcinoma of the esophagus and cardia.

2000 Canadian Journal of Surgery

149. Pharmacogenomics-based treatment of helicobacter pylori infection

on internal validity, the clinical relevance of the study is also limited for several reasons. The treatment approach used was relatively intensive, including genetic testing for CYP2C19, EGD with biopsy for all patients, and testing of H. pylori isolates for clarithromycin resistance. This treatment approach is much more intensive than generally used in the U.S., where the diagnosis of H. pylori is usually made by noninvasive methods and initial empiric treatment is instituted without isolating H. pylori (...) or testing for resistance. Furthermore, the patient population was from Japan, limiting the generalizability of the results, especially given the higher prevalence of CYP2C19 polymorphisms in the Asian population compared to that in Caucasian populations. Alternative treatment strategies exist for eradicating H. pylori that address some of the issues raised by CYP2C19 variability but do not rely on testing for CYP2C19 status. For example, empiric treatment with higher-dose PPI for all patients might

2008 Health Technology Assessment (HTA) Database.

150. An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori

Helicobacter pylori Consensus Conference that it is the preferred noninvasive test for H. pylori. Most general practitioners in Canada have access only to serologic testing for the diagnosis of H. pylori infection. There is evidence that a negative H. pylori test result may provide as much reassurance for patients as a normal result of endoscopy.[ , ] This is discussed further in the section "Testing for H. pylori infection." In deciding on a noninvasive H. pylori test-and-treat strategy in patients (...) to test for H. pylori infection, but symptoms alone are inadequate to exclude this diagnosis in a patient with dyspepsia. Testing for H. pylori infection: Recent guidelines from the Canadian Helicobacter pylori Consensus Conference include an overview of diagnostic tests for the detection of H. pylori infection. Infection can be detected by invasive (endoscopy based) or noninvasive (UBT or serologic testing) diagnostic tests. For serologic testing, both laboratory (serum) and office-based (whole blood

2000 CPG Infobase

151. Helicobacter pylori. The latest in diagnosis and treatment

are summarised in Table 3. Background European and North American guidelines on the management of Helicobacter pylori infection were updated in 2007. New diagnostic methods have been introduced and in Australia, the recommended therapy choices in cases of penicillin allergy and for second line treatment are only accessible through the Therapeutic Goods Administration Special Access Scheme. Objective The article aims to update general practitioners on recommendations for testing and treating H. pylori (...) factors are present. Helicobacter pylori eradication seems to have a different effect in chronic and naive NSAID users. 5,6 Dyspepsia A test and treat strategy for H. pylori infection is recommended for patients with uninvestigated persistent dyspepsia who are less than 45 years of age without any of the following ‘alarm features’: • bleeding • anaemia • early satiety • unexplained weight loss • progressive dysphagia • odynophagia • recurrent vomiting • family history of gastrointestinal cancer

2008 The Royal Australian College of General Practitioners

152. Can you give me the basic details of a stool antigen test for H. pylori. info re sensitivity, specificity, cost etc would be useful especially in contrast with the urea breath test.

details of a stool antigen test for H. pylori. info re sensitivity, specificity, cost etc would be useful especially in contrast with the urea breath test. A 2005 review published in the Journal of Clinical Pathology [1]. This answers the question “Which non-invasive helicobacter test should I use?” reporting: “The most accurate test (95% specificity and sensitivity) is the urea breath test, which detects current infection. This is available on prescription (FP10 BNF section 1.3.1). It requires (...) Journal of Gastroenterology has published a systematic review of accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection [2], this gives results covering a variety of tests and scenarios and can be read by following the URL below. It concludes: “Monoclonal SAT is an accurate noninvasive method both for the initial diagnosis of H. pylori infection and for the confirmation of its eradication after treatment. The monoclonal technique has higher sensitivity than the polyclonal

2007 TRIP Answers

153. Establish Epidemiologic Data of H. Pylori Infection in Children and Adolescents-Using C13-UBT

cancers in adulthood. This is particularly relevant because infection dating from childhood appears to enhance the risk of carcinogenesis. Because H. pylori infection is contracted primarily during the childhood years, additional epidemiological studies among pediatric populations are imperative. Therefore the validation of an inexpensive, easy-to perform, sensitive, specific, and noninvasive diagnostic test for H. pylori infection in children and adolescents is of paramount importance to enhance our (...) presently limited understanding of H. pylori-related diseases. The optimal noninvasive tests for epidemiological research of H. pylori infection in children are still not well identified. Serologic immunoassays based on H. pylori antigens require validation in the pediatric population under evaluation. As the result of our previous study, the serological test was not sensitive enough as an epidemiology screening tool for H. pylori infection in children.The aims of this prospective study are: (1

2005 Clinical Trials

154. Effects of a specially designed fermented milk product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori in children: a prospective randomized double-blind study. (Abstract)

Effects of a specially designed fermented milk product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori in children: a prospective randomized double-blind study. To determine the efficacy of triple therapy supplemented with a specially designed fermented milk product containing specific probiotic Lactobacillus casei (L. casei) DN-114 001 strain on Helicobacter pylori eradication in children.Lactobacillus species possess in vitro activity against H. pylori (...) . There are no consistent data on the impact of eradication therapy supplemented with probiotics on H. pylori cure rates in childhood in vivo.Multicenter, prospective, randomized, double-blind controlled study. Eighty-six symptomatic H. pylori-positive children were randomized either to receive the control treatment of omeprazole, amoxicillin, and clarithromycin (OAC) for 7 days or the test treatment of omeprazole, amoxicillin, and clarithromycin for 7 days supplemented with fermented milk (Actimel) containing L. casei

2005 Journal of clinical gastroenterology Controlled trial quality: predicted high

155. Noninvasive tests as a substitute for histology in the diagnosis of Helicobacter pylori infection Full Text available with Trip Pro

contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of invasive and noninvasive tests for the diagnosis of Helicobacter pylori (H. pylori) infection in patients with a negative rapid urease test (RUT). The diagnostic tests considered were histology (based on 1 fundic and 2 antral biopsies), 13-C Urea Breath Test (UBT), FlexSure HP whole blood test, FlexSure HP (...) was performed. Authors' conclusions The noninvasive rapid antibody tests were at least as accurate (if not more accurate) as 13-C urea breath test (UBT) and histology in detecting Helicobacter pylori (H. pylori) in patients with a negative rapid urease test (RUT), and were significantly less expensive. In addition, the rapid antibody noninvasive tests provided an immediate result. Histology was the least cost-effective strategy as it missed a substantial percentage of infected patients in this population

2000 NHS Economic Evaluation Database.

156. Posttreatment 13C-urea breath test is predictive of antimicrobial resistance to H. pylori after failed therapy. Full Text available with Trip Pro

Posttreatment 13C-urea breath test is predictive of antimicrobial resistance to H. pylori after failed therapy. We tested whether a 13C-urea breath test can predict antimicrobial resistance of Helicobacter pylori (H. pylori).Seventy patients who had failed triple eradication therapy and 108 untreated H. pylori-infected patients were given a 13C-urea breath test, endoscopy for culture of H. pylori, and assessment of clarithromycin resistance. The patients who had failed triple therapy (...) and predicts efficacy of the rescue regimen. The value of the noninvasive test is promising for primary care physicians who need to select a rescue regimen without invasive H. pylori culture.

2005 Journal of General Internal Medicine

157. 13C urea breath test for (Helicobacter pylori): evaluation of 10-minute breath collection. Full Text available with Trip Pro

13C urea breath test for (Helicobacter pylori): evaluation of 10-minute breath collection. AIM: To determine whether a shortened (13)C urea breath test ((13)C UBT) (breath collection time of 10 min) is as reliable as the standard assay (30 min). METHODS: Two hundred ninety-seven patients (mean +/- SD: 53+/-16 years, 57% female) completed a (13)C UBT. Breath samples were obtained at baseline and at 5 min intervals up to 30 min. Sixty-seven patients also underwent endoscopic biopsy. Cluster (...) is an accurate, noninvasive test, even when the breath sample interval is reduced to 10 min. The present study confirms the validity of a cut-off point of 3.0 delta/1000 for the 10 min and 30 min (13)C UBT.

2007 EvidenceUpdates

158. 13C urea breath test for (Helicobacter pylori): determination of the optimal cut-off point in a Canadian community population. Full Text available with Trip Pro

/1000 for the diagnosis group (n=1209) and 2.88 delta/1000 for the post-treatment group (n=1023). When replacing the calculated cut-off points by a practical cut-off point of 3.0 delta/1000, the risk of false-positive and false-negative results was lower than 2.3%. The (13)C UBT showed 100% sensitivity and 98.5% specificity compared with histology and microbiology (n=176) for the diagnosis of active (H pylori) infection. CONCLUSIONS: The (13)C UBT is an accurate, noninvasive test for the diagnosis (...) 13C urea breath test for (Helicobacter pylori): determination of the optimal cut-off point in a Canadian community population. AIM: To determine the test characteristics and the optimal cut-off point for the (13)C urea breath test ((13)C UBT) in a Canadian community laboratory setting. METHODS: Of 2232 patients (mean age +/- SD: 51+/-21 years, 56% female) who completed a (13)C UBT, 1209 were tested to evaluate the primary diagnosis of (Helicobacter pylori) infection and 1023 were tested

2007 EvidenceUpdates

159. Stool antigen assay to screen H. pylori infection and to assess the success of 3-Day and 7-Day eradication therapy in the patients with partial gastrectomy. (Abstract)

Stool antigen assay to screen H. pylori infection and to assess the success of 3-Day and 7-Day eradication therapy in the patients with partial gastrectomy. Even after partial gastrectomy, Helicobacter pylori may persist in the residual stomach but be less abundant in the bacterial load. H. pylori stool antigen is a reliable noninvasive tool to detect H. pylori infection in patients without gastrectomy. We thus test whether [1] the course of H. pylori eradication therapy could be diminished [2 (...) ]; stool antigen can effectively detect H. pylori infection for the patients with gastrectomy.One hundred and eight patients who had undergone partial gastrectomy were enrolled to receive panendoscopy and provided stool samples for H. pylori stool antigen within 3 days after endoscopy. The H. pylori-infected patients were then randomized to receive either a 3- or 7-day triple therapy for H. pylori eradication. Six weeks later, to evaluate the success of H. pylori eradication, patients received a follow

2002 Helicobacter Controlled trial quality: uncertain

160. Use of a Novel Enzyme Immunoassay Based on Detection of Circulating Antigen in Serum for Diagnosis of Helicobacter pylori Infection Full Text available with Trip Pro

Use of a Novel Enzyme Immunoassay Based on Detection of Circulating Antigen in Serum for Diagnosis of Helicobacter pylori Infection Recently, noninvasive diagnostic tests for Helicobacter pylori infection have gained in significance. We have developed a sensitive and specific noninvasive immunoassay based on the detection of an H. pylori circulating antigen (HpCA) in sera from H. pylori-infected individuals. Monospecific antibody and Western blot analyses were used to demonstrate the presence (...) , specificity, and efficiency (>90%), and ELISA results show no significant difference (P > 0.05) from results of H. pylori culture of gastric biopsy specimens. The test's positive and negative predictive values were also high (95 and 86%, respectively). In conclusion, a sensitive and specific immunoassay was developed for the detection of HpCA in human serum. This test can be applied for noninvasive laboratory and field diagnoses of H. pylori infection.

2004 Clinical and Diagnostic Laboratory Immunology

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