The 13carbon urea breath test for the diagnosis of Helicobacter pylori infection in subjects with atrophic gastritis: evaluation in a primary care setting.

BACKGROUND: (13)Carbon urea breath testing is reliable to detect current infection with Helicobacter pylori but has been reported to be of limited value in selected patients with atrophic body gastritis or acid-lowering medication. AIM: To evaluate the accuracy of (13)carbon urea breath testing for H. pylori detection in 20 asymptomatic patients with histologically confirmed atrophic body gastritis in a primary care setting. METHODS: (13)Carbon urea breath testing and serology were compared with H. pylori culture of a corpus biopsy as reference test. RESULTS: All tests were in agreement in 12 patients, being all positive in six and all negative in six. One patient was positive for serology and culture but negative for (13)carbon urea breath testing, five patients had only positive serology and two patients had only positive (13)carbon urea breath testing. (13)Carbon urea breath testing showed an accuracy with culture of 85% and anti-H. pylori serology with culture of 75%. (13)Carbon urea breath testing carried out in patients with positive serology showed an accuracy of 92%. Receiver operating characteristic curve analysis of (13)carbon urea breath testing shows optimal discrimination at the prescribed cut-off value. CONCLUSIONS: (13)Carbon urea breath testing can be used as diagnostic H. pylori test in asymptomatic patients with atrophic body gastritis, preferably in addition to serology, to select subjects for anti-H. pylori therapy.

[Policy in patients with epigastric complaints]. / Beleid bij patiënten met bovenbuikklachten.

In the relatively young dyspeptic patient without alarming symptoms both the test-and-treat approach and the empirical acid-inhibition therapy have proved to be effective non-invasive management strategies. When these strategies are followed, a minority of the patients subsequently need endoscopy. Additional well-designed studies are needed to compare the non-invasive management strategies test-and-treat and empirical acid inhibition in a primary-care setting. The individual general practitioner is advised to follow the guidelines applied in their region. These regional management strategies are usually based on the national guidelines and the facilities available in the region. In the absence of a regional management strategy it is recommended to follow the national guidelines.

The serological gastric biopsy: a non-endoscopical diagnostic approach in management of the dyspeptic patient: significance for primary care based on a survey of the literature.

BACKGROUND: Measurement of the serum concentration of the secretory products of the gastric mucosa, pepsinogen A (PgA), pepsinogen C (PgC) and gastrin is called the serological gastric biopsy. Additional measurement of Helicobacter pylori antibodies and antibodies to parietal cells and intrinsic factor supports the non-invasive diagnostic value of the serum markers. In many clinical studies, the diagnostic potential of the serum markers in predicting the topography and severity of gastric mucosal disorders has been established. The aim was to assess the diagnostic value of the serological gastric biopsy for primary care. METHOD: Survey of the literature. RESULTS: The cell-physiological background of the serological gastric biopsy, the interpretation of the outcome of serum markers and the relation of these parameters to various gastric mucosal disorders are described. Measurement of PgA is a reliable way to discriminate between mucosal gastritis and functional dyspepsia. PgA is raised in duodenal, gastric and pyloric ulcer even though gastrin is normal. Both PgA and gastrin are raised in renal insufficiency and the Zollinger-Ellison syndrome. A low PgA is indicative of mucosal atrophy and a good indicator for gastric hypoacidity. An additional low PgA:C ratio is indicative of atrophic gastritis or extensive intestinal metaplasia of the stomach. A hypopepsinogenaemia can also be an alarm symptom for gastric cancer. A low PgA and a high gastrin is indicative of corpus atrophy. CONCLUSION: In primary care, the serological gastric biopsy might be a feasible and appropriate diagnostic method for management of the dyspeptic patient. Further research in general practice has to be done to validate the predictive value of the serological gastric biopsy and to define a diagnostic strategy.

Reaction of the vaginal flora to ornidazol in patients with cervicitis.

The cervical and high vaginal flora of 76 patients with cervicitis were studied before and after therapy with Ornidazol by quantitative culture methods. Lactobacilli were the predominant organisms, but Peptostreptococci, Bacteroides and Trichomonas were encountered in 17, respectively 32 and 81% of all specimens. During and after therapy Trichomonas disappeared completely, the bacterial flora normalized and became comparable to that of healthy women with incidences for Bacteroides of 8-13% and Peptostreptococci of 4-5%. The in vitro susceptibility (MIC and MBC) of 50 strains of Bacteroides to Ornidazol was determined by a broth dilution method and an agar plate technique. The MIC varied from 0.07 to 10 microgram/ml. All strains were susceptible to 10 microgram/ml. There was a slight variation in resistance between the various species tested. B. fragilis was less susceptible to Ornidazol than other Bacteroides species. Within the species B. fragilis the subspecies thetaiotaomicron and 'other' were most susceptible, spp. fragilis and spp. distasonis least.