ABSTRACT To determine genetic susceptibility factors for Helicobacter pylori infection, polymorphic T-cell receptor gene elements were investigated in 203 H. pylori -infected individuals and 180 uninfected individuals (controls). H. pylori infection is highly associated with individuals homozygous for the nonfunctional TCRBV6S1B element (odds ratio = 5.9; χ 2 = 13; P = 0.00032; P value corrected for multiple comparisons [Bonferroni correction] = 0.00063).
Abstract Background and Aim: An algorithm (GastroPanel) for the non‐invasive diagnosis of atrophic gastritis has been previously proposed, based on serum pepsinogen‐I, gastrin‐17, and Helicobacter pylori ( H. pylori ) antibodies. The aim of the present study was to evaluate whether serum markers correlate with and predict gastric atrophy in gastroesophageal reflux disease (GERD) patients. Methods: The baseline data of the prospective ProGERD study, a study on the long‐term course of GERD ( n = 6215 patients), served to select patients with atrophic gastritis diagnosed in biopsies from gastric antrum and corpus, and control cases without atrophy. A total of 208 pairs were matched for age, sex, GERD status (erosive vs non‐erosive), presence of Barrett's esophagus, and histological H. pylori status were retrieved. Serum pepsinogen‐I, gastrin‐17, and H. pylori antibodies were determined using specific enzyme immunoassays. Results: A significant negative correlation was found between the degree of corpus atrophy and the level of serum pepsinogen‐I. A previously‐reported negative correlation between the degree of antral atrophy and serum gastrin‐17 could not be confirmed. The low sensitivity (0.32) and specificity (0.70) of the GastroPanel algorithm were mainly due to over diagnosis and under diagnosis of advanced atrophy in the antrum. Conclusion: The diagnostic validity of the GastroPanel algorithm to diagnose gastric atrophy non‐invasively is not sufficient for general use in GERD patients.
Pre-pouch-Ileitis beschreibt eine Beteiligung des Ileums an einer Colitis ulcerosa nach Proktocolektomie. Etwa 5% der Patienten nach Proktocolektomie sind betroffen, stets in Kombination mit einer Pouchitis. Die Prävalenz bei Pouchitis wird mit 13% angegeben.
Currently, endoscopy, computed tomography or laparoscopy are the preferred techniques for assessing complications (stenosis, fistula, abscess) of Crohn's disease but these are invasive or utilizing ionizing radiation. Since patients with Crohn's disease may require frequent evaluation, there is a high need for a non-invasive method. In recent years, transabdominal ultrasound has been proposed as a method to assess Crohn's disease complications. The aim of this prospective study was to evaluate High Resolution Ultrasound by blinded comparison with the current diagnostic standard.
Background. Serological rapid whole‐blood tests for the detection of H. pylori are presently being promoted for use in primary care. We conducted a multi‐center study to investigate the diagnostic accuracy of the Boehringer Mannheim Helicobacter pylori ® test (BM test), which is identical with the Cortecs Helisal® test. Patients and Methods. A previous diagnosis of H. pylori , a history of peptic ulcer diseases, or proton‐pump inhibitor, bismuth or antibiotic use during the preceding month were exclusion criteria. The BM test was performed prior to endoscopy by 7 primary care physicians, 5 practicing gastroenterologists, or a single physician in the university hospital outpatient service. During endoscopy, antral and corpus biopsies were obtained for histology and rapid urease testing (RUT). H. pylori positivity was defined by histology and/or RUT as reference methods. H. pylori IgG‐ELISA was performed additionally. Results. Of the 203 patients included, 151 were H. pylori ‐positive by reference methods (74.4%). The overall accuracy of the BM test was 77.3%. Eight BM tests were indeterminate, and in the other 195 patients the test performed as follows: sensitivity 80.3%, specificity 81.3%, positive predictive value 92.9%, negative predictive value 57.4%. Using IgG‐ELISA as reference, the BM test performance was similar. It also did not differ substantially among the three groups of physicians involved. Conclusions. We found the performance of the BM test to be insufficiently accurate, as both over‐ and underdiagnosis of H. pylori infection were not infrequent. This test needs to be improved before its use in primary care can be recommended.
Antibiotic resistance is a major cause of treatment failure in eradicating H. pylori and subsequent relapse of disease symptoms.Cost considerations have limited the number of studies comparing resistance pre and post treat- ments, and monitoring effect of resistance pre-treatment on eradication.What is the degree of resistance determining treatment failure?This study was performed to measure three parameters 1) Minimum inhibitory concentration (MIC) of metronidazole (met) and clarithromycin (clar) against resistant strains 2) the numbers of resistant organisms within the total populations and 3) their stability, both in numbers and sensitivity over a range of subcultures. 10strains comprising of 9 freshly obtained clinical isolates and one laboratory generated resistant strain were studied. 3clinical strains were found to be resistant to both clar and met, only 2 of the clinical isolates were sensitive.MICs against met ranged from 31-250 ,ug/ml for the resistant isolates, 2 ,ug/ml against the sensitive.Against clar resistant strains,MIC ranged from 31-250,ug/ml, as opposed to 0.03-0.13itg/ml for sensitive isolates.One strain showed intermediate susceptibility, MIC 2 ,ug/ml.There was wide variation in the numbers of organisms found to be resistant in the populations, ranging from 1 in 105 to totally resistant.Sensitive strains acquired resistance in < 1 in 108.The numbers of organisms found to be resistant was stable over 10 sub-cultures for 8 isolates, but an increase in clar susceptibility was found in the intermediate strain and 1 isolate.These studies have shown there are not just drug resistant and sensitive H. pylori strains.Emergence of resistance may not always be observed in strains that appear resistant.The numbers of resistant organisms within a population may be as important as the susceptibility of the isolates to antibiotics.
<i>Background/Aims:</i> There are still ongoing controversies as to which histological parameters allow the diagnosis of gastroesophageal reflux disease (GERD). The aim of the present analysis was to relate histological changes of the esophageal squamous epithelium to different severities of GERD. <i>Methods:</i> Data were obtained from patients participating in the ProGERD study, who had either erosive reflux disease (ERD, n = 3,245) or non-erosive reflux disease (NERD, n = 2,970). 1,475 patients fulfilled our requirement of having complete biopsy data from two sites (2 cm above the z-line and at the z-line). Changes in the squamous epithelium were assessed by measuring the thickness of the basal cell layer and elongation of the papillae as a percentage of the whole epithelial thickness and counting interepithelial inflammatory cells. <i>Results:</i> The most useful parameters for histological assessment of GERD (given as means, 2 cm above the z-line and at the z-line, respectively) were elongation of the papillae: NERD 40.7 and 48.9%; ERD 46.1 and 54.9% and basal cell hyperplasia: NERD 12.7 and 17.9%; ERD 15.7 and 23.0%. The occurrence of intraepithelial lymphocytic infiltrates, however, is dependent on the severity of GERD, and they are more common than neutrophilic and eosinophilic granulocytes. <i>Conclusion:</i> This study shows that both NERD and ERD can be diagnosed histologically if biopsies are obtained from the distal esophagus or from the z-line. Intraepithelial inflammatory cells are rare and show a high specificity, but very low sensitivity.
Dyspepsia is common in gastric cancer, but also in many benign conditions. European Helicobacter pylori Study Group and American Gastroenterological Association guidelines recommend endoscopy in dyspepsia for patients with alarm symptoms or at age >45 years. However, recommendations are controversial.To investigate whether criteria for endoscopy in patients with dyspepsia are adequate to detect gastric cancer.In 215 patients at initial diagnosis of gastric adenocarcinoma, symptoms were classified as alarm and non-alarm. Cases were staged according to the TNM system. Stages T(1)-T(3)N(x)M(0) were defined as potentially curable.Dyspepsia was present in 128 patients. Among patients with dyspepsia, 15 were < or =45 years and 41 denied alarm symptoms. The combination of both criteria excluded only three (2.3%) patients from endoscopy, but increasing the threshold to >50 and >55 years would have raised the rate of excluded patients to seven (5.5%) and 11 (8.6%). Only 53 potentially curable stages and 18 early gastric cancers occurred, but the tumour stage was not associated with dyspepsia duration, age threshold of 45 years, or alarm symptoms.Our results support current European Helicobacter Study Group and American Gastroenterological Association criteria for endoscopy in patients with dyspepsia to detect gastric cancer. Regardless, most cancers are advanced at detection.
