Differentiation between malignant and benign gastric ulcers: CT virtual gastroscopy versus optical gastroendoscopy.

PURPOSE: To retrospectively compare computed tomographic virtual gastroscopy (VG) and conventional optical gastroendoscopy for the differentiation of malignant and benign gastric ulcers. MATERIALS AND METHODS: The institutional review board approved this study and confirmed that informed consent was not required. Gastric ulcers in 115 patients (mean age, 64.7 years; range, 31-86 years; 61 men, 54 women) were evaluated by using endoscopy and VG. Ulcer shape, base, and margin and periulcer folds were evaluated by two independent reviewers. Malignant gastric ulcers were identified by irregular, angulated, or geographic shape; uneven base; irregular or asymmetric edges; and disrupted or moth-eaten appearance of periulcer folds near the crater edge and/or clubbed or fused folds. Benign gastric ulcers were identified by smooth and regular shapes, even bases, clearly demarcated and regular edges, and folds that tapered and converged toward the ulcer. The performance of VG and endoscopy for the diagnosis of benign and malignant gastric ulcers was evaluated by using histopathologic results as the reference standard. The McNemar test was used to compare VG and endoscopic data. A P value less than .05 was considered to indicate a significant difference. RESULTS: At histopathologic examination, 39 gastric ulcers were benign, while 76 were malignant. VG and endoscopy had sensitivities of 92.1% (70 of 76) and 88.2% (67 of 76), respectively, for overall diagnosis of malignant gastric ulcers, and specificities of 91.9% (34 of 37) and 89.5% (34 of 38), respectively, for overall diagnosis of malignant gastric ulcers. Endoscopy was more sensitive in depicting malignancy according to ulcer base (85.5% [65 of 76] vs 68.4% [52 of 76]) (P = .034), and VG was more specific in depicting malignancy according to ulcer margin (78.4% [29 of 37] vs 63.2% [24 of 38]) (P = .034). CONCLUSION: VG and endoscopy were almost equally useful in distinguishing between malignant and benign gastric ulcers. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2522081249/DC1.

Efficacy of levofloxacin-based rescue therapy for Helicobacter pylori infection after standard triple therapy: a randomized controlled trial.

OBJECTIVES: This prospective study was designed to determine the efficacy of a levofloxacin-based rescue therapy for Helicobacter pylori infection after failure of standard triple therapies. We also surveyed the predictors of this rescue therapy. PATIENTS AND METHODS: From June 2005 to March 2007, 1036 patients infected with H. pylori received standard triple regimens (proton pump inhibitor, clarithromycin and amoxicillin). H. pylori eradication was achieved in 855 (82.5%) subjects. One hundred and sixty-six eradication-failure patients were enrolled and randomly assigned to receive a 7 day eradication therapy with esomeprazole, bismuth subcitrate, tetracycline and metronidazole (EBTM) or esomeprazole, amoxicillin and levofloxacin (EAL). Follow-up endoscopy was done 16 weeks later to assess the treatment response. Patients' response, CYP2C19 genotypes and antibiotic resistances were also examined. RESULTS: Intention-to-treat analysis revealed that both groups showed similar eradication rates [EBTM 63.9%; 95% confidence interval (CI): 53.6-74.2 and EAL 69.9%; 95% CI: 60.1-79.7] (P = 0.89). Per-protocol results were EBTM = 84.1% (95% CI: 75.1-93.1) and EAL = 75.3% (95% CI: 65.8-84.8) (P = 0.82). Both regimens had similar compliance (P = 0.32), but the EBTM group had more adverse events (P = 0.27). Logistic regression analysis showed that poor compliance, CYP2C19 homozygous extensive metabolizer genotype and levofloxacin resistance were important predictors for eradication failure. CONCLUSIONS: The EAL regimen can achieve an efficacy similar to that of the standard EBTM therapy. It may be very useful in countries where bismuth salts are not available. Compliance, CYP2C19 genotype and resistances to antibiotics may influence the outcome of levofloxacin-based rescue therapy. It seems advisable to reserve levofloxacin for rescue treatment to avoid an increase in the resistance phenomenon.

A better method for confirming Helicobacter pylori infection in Mongolian gerbils.

BACKGROUND: Our aim was to evaluate the accuracy of the stool antigen test and the optimal time point for detecting Helicobacter pylori infection in a Mongolian gerbil model. METHODS: We inoculated 8-week-old Mongolian gerbils with H. pylori (Vac A (+)/CagA(+)). The gerbil-infected model was developed as follows: H. pylori was put into broth (about 10(9) CFU/ml), and 50 gerbils were then fed with 1 ml intragastrically twice within a 3-day interval. Another ten gerbils were fed broth only. Twenty-six weeks after the inoculation, the gerbils were killed. The gastric mucosa was sampled for a series of examinations including culture, histology, rapid urease test, and polymerase chain reaction. Stool samples for a stool antigen test, H. pylori-specific stool antigen assay (HpSA), were collected during weeks 4, 6, 8, 12, and 26 after inoculation. Of the 50 gerbils inoculated with H. pylori, the inoculation was successful in 88%. Severe active gastritis, ulceration, and intestinal metaplasia were obvious. RESULTS: The HpSA test results were sensitivity, 88.6%; specificity, 100%; positive predictive value (PPV), 100%; negative predictive value (NPV), 54.5%, and accuracy, 90%. The HpSA test began to be more sensitive and accurate (P < 0.05) beginning during week 6 after inoculation. We also found that H. pylori could be detected earlier and more easily in the group with high H. pylori density. CONCLUSIONS: HpSA seems to be suitable for confirming colonization of gerbils with H. pylori. The optimal testing time point is around 6 weeks after inoculation. This test is a good choice for long-term observation of H. pylori infection in Mongolian gerbils.

A better method for preventing infection of percutaneous endoscopic gastrostomy.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has been widely used to maintain enteral nutrition in dysphagic patients. Local and occasional life-threatening systemic infections are still the most common complications, and the major infection source may be nosocomial flora. The effect of antibiotic prophylaxis on reducing peristomal infection is popularly accepted. However, it is accompanied with a possible risk of increasing antibiotic resistance. AIM: This study attempted to determine whether 14-day discharge before PEG could reduce the rate of peristomal infection. MATERIALS AND METHODS: Fifty patients who had received PEG in our hospital were included in this study and followed for at least 6 months (except for those patients who died during this period). Patients were separated into two groups randomly. Twenty-five patients received PEG during in-hospitalization (group A). The other 25 patients received PEG until discharge at least for 14 days (group B). The most frequent indication for PEG insertion was the neurological condition. Risk factors for peristomal infection were analyzed statistically using logistic regression and expressed by odds ratios. Every possible factor was analyzed by chi-square test or Student's t test. RESULT: Our data showed that group A had a higher peristomal infection rate than group B (32 vs 8%) (p < 0.05). Group A also showed more need of antibiotics. The risk factors related to peristomal infection were group A and lower albumin. The total rate of 30-day mortality was 4%. DISCUSSION: When compared with previous data, our study showed a similar infection rate in group A, a lower infection rate in group B, and a lower 30-day mortality rate. This meant that one period of discharge could reduce the peristomal infections caused by colonized bacteria. It also decreased the need of using antibiotics and might avoid the possible adverse consequence of promoting bacterial resistance, which is an alarming and growing problem in hospital practice. CONCLUSION: We suggest that a 14-day grace period after discharge, before PEG insertion, may decrease peristomal infection rate, length of hospital stay after PEG, and the need for antibiotics. This is suitable for moral and ethical considerations.

The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer.

In patients with radically resected colorectal carcinoma, lymph node involvement is particularly important for a good prognosis and adjuvant therapy. The number of such lymph node recoveries is still controversial, with recommendations ranging from 6 to 17 nodes. The aim of this study is to determine if a specified minimum number of lymph nodes examined per surgical specimen can have any effect on the prognosis of patients who have undergone curative resection for T(2-4)N(0)M(0) colorectal carcinoma. Between September 1999 and January 2005, a total of 366 patients who underwent radical resection for T(2-4)N(0)M(0) colorectal carcinoma were retrospectively analyzed in a single institution. All specimen segments were fixed, with node identification performed by sight and palpation. We excluded 186 patients who received postoperative adjuvant chemotherapy via oral or intravenous transmission to prevent possible chemotherapeutic effects on patients' prognosis; therefore, a total of 180 patients with T(2-4)N(0)M(0) colorectal carcinoma were enrolled into this study. After the pathological examination, a mean of 12 lymph nodes (range 0-66) was harvested per tumor specimen. No postoperative relapse was found in this group, where the number of examined lymph nodes was 18 or more. Univariate analysis identified the size of the tumor, depth of invasion, grade of tumor, and number of examined lymph nodes, which were significantly correlated with postoperative relapse (all P < 0.05). Meanwhile, both the depth of tumor invasion and the number of harvested lymph nodes were independent predictors for postoperative relapse (P < 0.05). The 5-year overall survival rate of T(2-4)N(0)M(0) colorectal carcinoma patients who had 18 or more lymph nodes examined was significantly higher than those who had less than 18 nodes examined (P = 0.015). Nodal harvest in patients undergoing radical resection for colorectal carcinoma was highly significant in the current investigation. Our results suggest that harvesting and examining a minimum of 18 lymph nodes per surgical specimen might be taken into consideration for more reliable staging of lymph node-negative colorectal carcinoma.

Evaluation of the two immunochromatographic methods for detecting urine and serum IgG antibodies to Helicobacter pylori and comparison of accuracy and clinical utility.

BACKGROUND/AIMS: To evaluate the accuracy and clinical utility of two immunochromatographic methods, the STAT-PAK and RAPIRUN tests, in detecting H. pylori antibodies in serum and in urine separately. METHODOLOGY: 130 patients undergoing gastroendoscopy (70 men and 60 women; mean age, 50.6 years) were enrolled in this study. Their H. pylori status was determined based on 4 tests: CLO test, culture, histology and UBT test. The H. pylori positive status was confirmed when the culture was positive, or 2 of the other 3 tests were positive. Serum samples and urine samples were collected. We used the STAT-PAK test for detecting H. pylori antibodies in serum, and read the results 24 hours later. Antibodies were also detected in urine by the RAPIRUN test, with a reading time of 25 minutes. 3 doctors read the results of both tests separately, and a positive result was determined when at least 2 of the doctors read a positive result. RESULTS: In the STAT-PAK pretest using serum samples from 21 randomly selected patients (16 patients with H. pylori infection and 5 patients without infection), the sensitivity at 1-hour and 24-hour reading time was 18.7% and 37.5%. Specificity in both reading times was the same at 100%. Of 129 patients, 82 (64%) were H. pylori infected and 47 (36%) were uninfected. The sensitivity, specificity, and positive and negative predictive values were 31.7%, 93.6%, 89.6% and 44.0% in the STAT-PAK test with a 24-hour reading time, and 93.9%, 85.1%, 91.6%, 88.8% in the RAPIRUN test. One female was excluded because of an invalid urine test. CONCLUSIONS: The urine RAPIRUN test is a faster and more accurate office-based test than the serum STAT-PAK test for detecting the H. pylori infection in untreated patients in Taiwan. The non-invasive urine RAPIRUN test can be used as a large scale screening test for H. pylori status, particularly in children, uncooperative patients, those who have a family history of gastric cancer, or patients who can not tolerate the suffering of endoscopic examination.

Evaluating the validity of the serologic test for detecting Helicobacter pylori infection in Mongolian gerbils.

A strong correlation between Helicobacter pylori infection and gastric cancer has been reported. Mongolian gerbils are regarded as the most suitable animal model in which to study carcinogenesis associated with H. pylori. The aim of our study was to evaluate the accuracy of the serologic test for detecting H. pylori infection in Mongolian gerbils. The model was developed as follows: the H. pylori colony (vacuolating cytotoxin A (+)/cytotoxin-associated gene A (+)) was cultured from the mucosas of previously H. pylori-fed gerbils. These colonies were cultured in broth. Then,we fed the gerbils with 0.5-1 mL of broth (about 10(9) CFU/mL) (intragastric administration) twice within a 3-day period. After inoculation for 6 or 26 weeks, the gerbils were sacrificed and their gastric mucosas were sampled for a series of examinations. Blood samples for serologic testing (STAT-PAK) were collected. H. pylori infection was confirmed. Statistical analysis was performed using the Chi-square test. Differences were regarded as significant when the p value was less than 0.05. A total of 50 gerbils were inoculated with H. pylori and the success rate reached 88%. All 10 gerbils in the control group showed a negative result. Damage to the mucosas was more obvious following increasing periods of inoculation. The rates of sensitivity and specificity, as determined by the STAT-PAK test, were 90.9% and 100%, respectively. The positive and negative predictive values were 100% and 60%, respectively. The STAT-PAK test seemed to be more sensitive and accurate (p < 0.05) in high H. pylori densities. In conclusion, the STAT-PAK test (blood-sampling) showed acceptable results and was suitable for long-term observation of H. pylori infection.

The clinical applications and accuracy of 2 rapid near-patient tests in detecting Helicobacter pylori infection.

Noninvasive methods for assessing Helicobacter pylori infection status are now an integral part of managing patients with upper gastrointestinal complaints. The aim of this study is to evaluate the feasibility and diagnostic accuracy of 2 rapid tests: a urine-based H. pylori antibody detection method (Rapirun) and a stool-based H. pylori antigen detection method (immunocard STAT! HpSA). The combined use of the mentioned 2 tests was also evaluated, which has not been described in previous similar studies. Urine and stool specimens were collected from patients who were arranged for gastroendoscopic examination. The urine and stool specimens were tested with Rapirun and immunocard STAT! HpSA separately. The estimated reaction time was about 15 to 20 min for the former and 5 to 10 min for the latter. H. pylori infection was confirmed with 4 tests: culture, histology, rapid urease test, and the (13)C-urea breath test. Obtained results from both kits were compared with confirmed results. One hundred twenty patients were eligible for analysis. Of them, 62 tested positive for H. pylori infection and 58 were negative by the confirmation criteria. The urine Rapirun test relative to the confirmed results showed sensitivity, specificity, and accuracy as 87.1% (confidence interval [CI] = 81.1-93.1%), 89.7% (CI = 84.2-95.1%), and 88.3%, respectively. The stool immunocard STAT! HpSA test relative to the confirmed results showed sensitivity, specificity, and accuracy as 96.8% (CI = 93.6-99.9%), 82.8% (CI = 76.0-89.5%), and 90%, respectively. The combined-use method of both tests revealed sensitivity, specificity, and accuracy as 98.4% (CI = 96.1-100%), 81.0% (CI = 74.0-88.1%), and 90%, respectively. These 2 urine and stool tests have a satisfactory accuracy around 90% in detecting H. pylori infection. In consideration of the advantages of cheapness, timesaving, and ease of use, both can be used as rapid near-patient tests in general practice. The combined use of both tests was also promising in detecting H. pylori infection.

Clinical characteristics of patients with sporadic colorectal cancer and primary cancers of other organs.

Most cancer patients often neglect the possibility of secondary cancer. Colorectal cancer (CRC) is the third leading cause of cancer death in Taiwan. It is important to be aware of the clinical characteristics of double cancer in CRC patients for early diagnosis and treatment. We retrospectively analyzed 1,031 CRC patients who underwent surgical treatment at the Department of Surgery of Kaohsiung Medical University Hospital between January 1998 and December 2004. Among these patients, CRC was accompanied by cancer of other organs in 17 patients (1.65%), either synchronously or metachronously. Therefore, we describe our experience regarding the location of CRC, the clinical symptoms and signs of these patients, the TNM stage, histology, phase, association with other malignancies, interval between cancers and clinical outcomes. Of the 17 patients in whom CRC was accompanied by primary cancer of other organs, there were four synchronous and 13 metachronous multiple cancer patients. Our patient group comprised six men and 11 women with ages ranging from 47 to 88 years (median age, 66 years). The most common location of CRC was the sigmoid colon. Six gastric cancers (35.2%) and six breast cancers (35.2%) were associated with primary CRC. The remaining six second primary cancers were one lung cancer, one thyroid cancer, one cervical cancer, one ovarian cancer, one skin cancer, and one urinary bladder cancer. Of the 13 metachronous multiple cancer patients, eight patients developed subsequent CRC after primary cancers of other organs, whereas two patients developed a subsequent second primary cancer after CRC. The intervals between the development of metachronous multiple cancers ranged from 2 to 19 years. In this retrospective analysis, breast and gastric cancer patients were at increased risk of developing subsequent secondary CRC. Careful attention should always be paid to the possibility of secondary CRC in treating these cancer patients. Cancer patients with hematochezia or gastrointestinal symptoms/signs should be evaluated for the possibility of second primary CRC during their regular follow-up.

Successful localization and surgical removal of ingested sewing needles under mini C-arm fluoroscopy: a case report.

Foreign body ingestion is common, but ingestion of multiple sewing needles is rare. Most ingested sharp metallic bodies pass through the digestive tract spontaneously and patients can be managed conservatively. Sometimes, however, perforation develops and surgical treatment is necessary. It is hard to localize ingested sewing needles because they tend to scatter widely in the digestive tract and are impalpable manually. We report a psychiatric patient who ingested six sewing needles: one intact needle was found at the larynx, one had penetrated into the stomach, one was in the duodenum, one was in the cecum, one was broken into two pieces, and the final needle was broken into three pieces. All of the broken fragments were in the colon. The needle at the larynx was removed by a laryngoscope. Subsequently, we used mini C-arm fluoroscopy to localize the remaining needles and successfully removed all of them intraoperatively.

The best method of detecting prior Helicobacter pylori infection.

AIM: Prior Helicobacter pylori (H pylori) infection has often been underestimated. These underestimations have misled physicians attempting to determine the significance between H pylori and certain gastrointestinal lesions such as intestinal metaplasia, atrophic gastritis, and gastric cancer. Our study endeavored to detect past H pylori infections accurately, easily, and rapidly with the newly developed immunoblot kit, Helico Blot 2.1. METHODS: Thirty-three patients, including 25 H pylori infected and 8 uninfected cases, were enrolled in our study. All patients received consecutive gastroendoscopic examinations and (13)C-urea breath test (UBT) tests at 6- or 12-mo intervals for up to 4 years. Serum samples were obtained from each patient at the same time. Intragastric H pylori infection was confirmed in accordance with the gold standard. Twenty-five H pylori-infected patients received triple therapies after initial bacterial confirmation, and were successful in eradicating their infections. Serially obtained sera were tested by means of Helico Blot 2.1. RESULTS: Current infection marker detected by Helico Blot 2.1 was unreliable for representing ongoing H pylori infection. Only 35 and 37 ku antibodies of H pylori had significant seroconversion rates 1 year after having been cured. The seropositive rates of 116 ku (cytotoxin-associated antigen (CagA)) and Helico Blot 2.1 were nearly 100% during 4-year follow-up period. Both CagA antigen and Helico blot 2.1 could serve as indicators of long-term H pylori infection. CONCLUSION: Helico Blot 2.1 can detect past H pylori infections for up to 4 years, and is the best method to date for detecting previous long-term H pylori infection.

Preoperative evaluation of endoscopic ultrasonography and portography in selecting devascularization surgery for esophagogastric varices.

This study assesses the role of endoscopic ultrasonography (EUS) and portography in selection of mode of devascularization surgery for esophagogastric varices (EGV) in patients with portal hypertension and reports our experience in the treatment of EGV with modified devascularization surgery. Forty-two cirrhotic patients with EGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used as the guiding mode for therapy of EGV. In addition to devascularization and splenectomy, esophageal transection (ET) was performed in 26 patients with upward-flow varices (UFV), whereas 16 patients with downward-flow varices (DFV) underwent proximal gastrectomy instead of ET. In both UFV and DFV groups, grade II of intramural varices and extramural collaterals were most commonly observed on EUS imaging. There was no significant difference of EUS grading between these two groups (P > 0.05). The incidence of postoperative complications, mortality, and recurrent varices were not significantly different between these two groups. The overall 5-year survival rate for UFV group was 69.2 per cent, whereas that for the DFV group was 68.7 per cent (P > 0.05). Our study shows that devascularization surgery is highly effective for the prevention of recurrent bleeding from EGV, and it provides an alternative treatment modality. Combined PTP and EUS are very helpful in determining adequate modalities of devascularization surgery.

Comparison of 13C-urea breath test values in gastric cancer, peptic ulcer and gastritis.

BACKGROUND/AIMS: Results of urea breath test (UBT) are related to the severity of atrophic gastritis and the density of Helicobacter pylori (H. pylori). Recently, it has been reported that low UBT values should be considered to suggest the possibility of gastric cancer. This study compares UBT results in gastric cancer patients with those of peptic ulcer and gastritis patients. METHODOLOGY: Between October 1998 and May 2000, we have consecutively collected 564 H. pylori-positive patients: 128 gastritis patients, 72 gastric cancer patients, 64 gastric ulcer patients and 300 duodenal ulcer patients. Peptic ulcers were classified into active (A), healing (H), and scar (S) stages. Gastric cancer was classified into early stage (EGCA) and advanced stage (AGCA). The dose of 13C-urea was 50mg, and breath samples were analyzed with a mass spectrometer and the data was evaluated by Mann-Whitney test. The cut-off value was 3.5 per thousand. RESULTS: The mean UBT values of gastric cancer, gastric ulcer (GU), duodenal ulcer (DU) and gastritis were 16.95 +/- 12.2 per thousand, 16.3 +/- 9.3 per thousand, 15.13 +/- 9.9 per thousand and 20.07 +/- 13.5 per thousand. There were no significant differences in UBT values between gastric cancer and gastric ulcer (p = 0.745), duodenal ulcer (p = 0.3831), or gastritis (p = 0.2953). There were also no significant differences between subgroups of gastric cancer and gastric ulcer. There were significantly higher UBT values in the DU scar stage (p = 0.001) and healing stage (p = 0.0484) than in the active stage. CONCLUSIONS: We conclude that the UBT value is not a good method for the prediction of gastric cancer. In addition, based on the results of our study, the UBT values may explain the relationship between the natural course of duodenal ulcer and H. pylori infection.

Clinical and endoscopic features of non-steroidal anti-inflammatory drug-induced colorectal ulcerations.

BACKGROUND AND PURPOSE: Data on the clinical and endoscopic features of non-steroidal anti-inflammatory drug (NSAID)-induced colorectal ulcerations are very limited from Taiwan. We analyzed the clinical manifestations, endoscopic and histologic findings, and outcomes of patients with NSAID-induced colorectal ulcerations in Southern Taiwan. METHODS: From January 1997 to December 2001, 4200 patients underwent total colonoscopy at a tertiary referral center in Southern Taiwan. We retrospectively analyzed the medical records and endoscopic files. The diagnosis of NSAID colorectal ulceration required the following clinical, histologic and colonoscopic findings: patients presenting with gastrointestinal complaints were taking NSAIDs; presence of colorectal ulcerations confirmed by colonoscopy; no evidence of neoplasm or of specific inflammation in biopsy specimens obtained from the margins of ulcers; no evidence of pathogenic microorganism in cultures of biopsy specimens and stools; no prior history of chronic inflammatory bowel diseases; improvement of ulcers, as confirmed by endoscopy, and improvement of presenting symptoms after the discontinuation of NSAID therapy. RESULTS: NSAID-induced colorectal ulcerations were diagnosed in 19 (0.45%) of the 4200 patients, including 10 females and 9 males with a mean age of 64.7+/-15.4 years. Of the 19 patients, 13 presented with acute onset of painless rectal bleeding, 4 with nonspecific abdominal distress, and 2 with iron deficiency anemia, weight loss and lower abdominal pain. Colonoscopy revealed ulcerations in the ileocecal region in 11 patients, lesions in the distal rectum in 6, and colonic strictures with circumferential ulcerations on the central rim located in the ileocecal region in 2. Eight patients had comorbidity including renal failure (4), uncomplicated liver cirrhosis (2), and previous cerebrovascular accidents (2). Diclofenac and piroxicam were the most commonly involved drugs. Patients with acute onset rectal bleeding were also being treated with concomitant booster intravenous dose of NSAIDs before the bleeding episode. Most of the patients recovered uneventfully with the discontinuation of NSAID therapy. CONCLUSIONS: NSAID-induced colorectal ulceration is a clinically significant disease which may be under-recognized. Lower gastrointestinal tract evaluation should be considered in patients who are using NSAIDs and who have acute rectal bleeding, anemia and lower gastrointestinal complaints.

Effects of ingesting Lactobacillus- and Bifidobacterium-containing yogurt in subjects with colonized Helicobacter pylori.

BACKGROUND: Evidence suggests that ingesting lactic acid bacteria exerts a suppressive effect on Helicobacter pylori infection in both animals and humans. Supplementing with Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) was shown to improve the rates of eradication of H. pylori in humans. OBJECTIVE: We administered AB-yogurt to subjects with asymptomatic H. pylori to test whether the yogurt could inhibit H. pylori growth. DESIGN: The in vitro inhibition of H. pylori growth was determined by inoculating Lactobacillus acidophilus La5 or Bifidobacterium lactis Bb12 on plates that were inoculated with H. pylori. Assessment of the viability of H. pylori was performed by the mixed culture method with La5 or Bb12. In an intervention study, 59 adult volunteers infected with H. pylori were given AB-yogurt (10(7) colony-forming units of both La5 and Bb12/mL) twice daily after a meal for 6 wk. Eleven subjects positive for H. pylori infection were treated with milk placebo as control subjects. H. pylori bacterial loads were determined with use of the (13)C-urea breath test, which was performed before and 4 and 8 wk after the start of AB-yogurt supplementation. RESULTS: Bb12 exerted an in vitro inhibitory effect against H. pylori, whereas La5 did not show an effect. Administration of AB-yogurt decreased the urease activity of H. pylori after 6 wk of therapy (P < 0.0001). CONCLUSION: Regular intake of yogurt containing Bb12 and La5 effectively suppressed H. pylori infection in humans.

The clinical utility of string-PCR test in diagnosing Helicobacter pylori infection.

BACKGROUND/AIMS: Non-invasive string test has been reported as being convenient and capable of yielding bacteria by means of gastric juice sampling in the diagnosis of Helicobacter pylori infection. Molecular methods, such as polymerase chain reaction for the amplification of DNA, are desirable for the detection of minute quantities of H. pylori. We planned to evaluate the diagnostic efficiency of the combination of the string test and polymerase chain reaction and determine whether the string polymerase chain reaction test could obtain more information in conditions where the bacterial load is so low that other diagnostic tests fail to confirm the presence of H. pylori. METHODOLOGY: We enrolled 48 dyspeptic patients, including 29 males and 19 females, with a mean age of 52.5 years. Each patient received endoscopy and biopsy-based tests, including RUT (rapid urease test), cultures, and histology, followed by 13C-UBT (13Carbon urea breath test). We used the string test, (Entero-Test H. pylori, HDC Corporation, CA, US), for gastric juice sampling. The specimen was further analyzed by polymerase chain reaction for the presence of H. pylori with the primer for cagA gene, which is highly prevalent in Taiwan. H. pylori infection was considered as positive when either culture yield was positive, or when two of the other three tests, including RUT, histology, and 13C-UBT, were positive. RESULTS: Of the total 48 patients, 34 patients were H. pylori-positive, and 14 were H. pylori-negative. A fragment of 349 bp of polymerase chain reaction products was detected by agarose gel electrophoresis in 32 out of 34 patients who was classified as H. pylori-positive. The sensitivity, specificity, positive predictive value, and negative predictive value of the string polymerase chain reaction test were 94.12%, 96.97%, 92.86%, and 86.67%, respectively. These results are comparable to 13C-UBT and RUT, and better than histology and culture. One subject, who tested as H. pylori-negative according to the diagnostic criteria, had positive 13C-UBT and string polymerase chain reaction test results. Further sequencing of the DNA obtained from the results of polymerase chain reaction product was performed and it showed 98% identities with the known sequence of cagA strain H. pylori (GenBank accession number: AF249275). CONCLUSIONS: The string polymerase chain reaction test is non-invasive and provides direct bacterial yields. Its diagnostic efficiency is comparable with 13C-UBT and RUT in detecting H. pylori infection. Also, with the assistance of polymerase chain reaction and DNA sequencing, we can diagnose H. pylori infection even when the bacterial load is low. Further application of string polymerase chain reaction test in the genetic analysis of virulent and resistant strains seems promising.

Evaluation of a newly developed office-based stool test for detecting Helicobacter pylori: an extensive pilot study.

BACKGROUND/AIMS: Several strategies have been used to detect Helicobacter pylori (Hp) infection along two lines: 1) direct detection of the bacteria, and 2) detection of antigen-antibody assay against Hp. The non-invasive methods include ELISA test of serum, salivary and urine, urea breath test, and detection of Hp antigen in stool. The latter method (HpSA) has been proven reliable and better than the ELISA test, for it can detect current Hp infection and is suitable for post-treatment follow-up. Now, a new commercial kit, ImmunoCard STAT HpSA (Meridian Bioscience Europe) has been developed to detect stool Hp antigen. It is simpler and less time-consuming than HpSA. The aim was to examine whether ImmunoCard STAT HpSA is qualified for diagnosis of Hp infection. METHODOLOGY: 253 patients (163 men, 90 women, mean age: 53.3 +/- 13.9 y/o, range: 19-89 y/o) were enrolled in this study. All of them had undergone gastroendoscopy and urea breath test. 207 patients were diagnosed with peptic ulcer and 46 with gastritis. Stool samples were collected within 3 days of their visit for gastroendoscopy and were sent for the Immunocard test. RESULTS: 118 patients were diagnosed with Hp infection and of these, 113 were interpreted as positive by means of the Immunocard test. Among the other 135 patients without Hp infections, 123 were interpreted as negative by means of the Immunocard test. Sensitivity and specificity were 95.8% and 91.1%, and positive and negative predictive values were 90.4% and 96.1%. CONCLUSIONS: The ImmunoCard STAT HpSA had high sensitivity, and specificity and could be used for mass screening. We concluded that it is a rapid, simple, cheap, reliable, and non-invasive strategy to detect current Hp infection and can be used in post-Hp eradication follow-up in Taiwan.

The media of rapid urease test influence the diagnosis of Helicobacter pylori.

BACKGROUND/AIMS: The influence of different media on the validity of the rapid urease test, including accuracy, reaction time and cost-effectiveness is evaluated. METHODOLOGY: Biopsies were obtained from the antral and body mucosa of 100 KMUH patients (51 men, 49 women; mean age: 54.0 years, range: 21-79 years old) undergoing gastroendoscopy due to dyspepsia. None of the patients had received any Helicobacter pylori eradicating treatment, nor any other antibiotic or bismuth treatment in the previous one month, nor had they had any type of gastric operation in the past. Helicobacter pylori status was evaluated by seven different tests: culture, histology, home-made rapid urease test, 13C-urea breath test, and three different commercially available rapid urease tests--including the CLO test, the ProntoDry test, and the Pyloriset Urease test. Helicobacter pylori status was defined as positive when the culture was positive or if concordance of two of the other three tests (histology, homemade rapid urease test and 13C-urea breath test) was positive. RESULTS: Three different rapid urease tests have similar sensitivities (97.3% vs. 100% vs. 100%) and specificities (98.4% vs. 96.8% vs. 98.2%), and accuracy (98.4% vs. 96.8% vs. 98.2%). But the reaction time was longer in the CLO test than for the other two rapid urease tests (22.3 vs. 5.6 vs. 10.1 minutes) (P < 0.05). The ProntoDry test and the Pyloriset Urease test also have more rapid positive rate than CLO test. However, in vitro study, three tests show similar rapidity of positive reaction at different densities of Helicobacter pylori. CONCLUSIONS: These three tests have practical advantages for physicians who need a rapid and accurate method of diagnosing Helicobacter pylori infections. The ProntoDry test and Pyloriset Urease test have degrees of accuracy similar to the CLO test, but results are obtained more rapidly and they are cheaper. Furthermore, The ProntoDry test can be stored at room temperature and thereby save on the storage expense.

Comparison of serum and urine ELISA methods for the diagnosis of Helicobacter pylori--a prospective pilot study.

BACKGROUND/AIMS: Helicobacter pylori infection has a close relationship with many upper digestive tract diseases, but a gold standard for identifying this infection has not yet been well established, especially in clinical application. There is an increasing interest in non-invasive diagnostic tests. In this study, we will compare two non-invasive tests (ELISA method of urine and serum) in clinical use. METHODOLOGY: 170 patients (82 women, 88 men; mean age 52.4 yr) were included in this study and all underwent gastroendoscopy. None of the patients had received any H. pylori eradication therapy. The H. pylori infection status was evaluated by histology, culture, CLO test, and 13C-UBT. We also collected urine and serum for the ELISA method. H. pylori infection was defined as positive if the culture was positive or if two of the other three tests (histology, CLO test and 13C-UBT) were positive. If all four tests were negative or only one of the other three tests was positive, the result would be interpreted as negative. RESULTS: Of these 170 patients, 107 (62.94%) were H. pylori infected and 63 (37.06%) were uninfected. The sensitivity, specificity, positive predictive value and negative predictive value of serum ELISA were 96.26%, 74.60%, 86.55%, and 92.16% respectively; while those of urine ELISA were 93.46%, 92.06%, 95.24% and 89.23% respectively. There was no significant difference between these two tests in sensitivity, but urine ELISA has better specificity than serum ELISA significantly. CONCLUSIONS: Urine ELISA is a better non-invasive test for H. pylori infection than serum ELISA in clinical practice, because no blood need be drawn, it is safer, easier, and more convenient for sampling and has better specificity. Therefore it would be suitable in epidemiological screening of H. pylori infection, especially in young children, older patients and those who cannot cooperate.

Low molecular weight protein of Helicobacter pylori and its relation to gastroduodenal diseases.

BACKGROUND/AIMS: In Taiwan, CagA and VacA cannot be used as markers to evaluate the risk of developing serious gastroduodenal pathogenesis in the hosts. Recent research suggests that the low molecular weight proteins, 35kDa and 19kDa, in Helicobacter pylori may be related to duodenal ulcers and gastric MALToma (mucosa-associated lymphoid tissue lymphoma) respectively. The aims of this study were to examine the sero-prevalence of antibodies against specific Helicobacter pylori antigen in patients with different gastroduodenal diseases and further to find possible virulence factor(s) associated with the development of clinically relevant disease in Helicobacter pylori-infected subjects in Taiwan. METHODOLOGY: Sera were obtained from 108 patients, of which 22 had gastric adenocarcinoma, 31 had non-ulcer dyspepsia and 65 had peptic ulcer disease. The sera were analyzed for specific Helicobacter pylori antigen by using one commercial kit (HelicoBlot 2.0, Genelabs Diagnostic, Singapore, HB2.0). Helicobacter pylori infection was confirmed when the culture was positive or when any two of the other three tests (biopsy CLO test, histology and 13C-urea breath test) were positive. RESULTS: The data showed a high prevalence of CagA and VacA proteins [CagA(+): gastric adenocarcinoma--88.1%, non-ulcer dyspepsia--87.1%, peptic ulcer disease--91%; VacA(+): gastric adenocarcinoma--78.6%, non-ulcer dyspepsia--58.1%, peptic ulcer disease--71.4%] in Taiwan. This is similar to the findings in other Chinese and Taiwanese studies. No significant difference was found among the three groups (P > 0.05) for any Helicobacter pylori protein. We found that antibody responses to the 26.5-kDa and 116-kDa (CagA) antigens were most prevalent in the peptic ulcer disease group. Consequently, we analyzed two special phenotypes, which have simultaneous presence in bands at 116 and 26.5kDa. The phenotype [116-kDa (+) and 26.5kDa(+)] predicted the risk of peptic ulcer disease with 76.7% sensitivity and 62% specificity. CONCLUSIONS: We confirm the universal prevalence of CagA and VacA-positive Helicobacter pylori infection in Taiwan independent of disease. Although we did not find any single specific Helicobacter pylori protein which could act as an indicator of clinical outcome, we found a possible marker of peptic ulcer disease which may be acceptable. This is the phenotype with simultaneous presence in bands at 116kDa and 26.5kDa protein. Our report differs from some previous reports from other regions. This may reflect differences of race and geography.