Agreement and Intraobserver Variability in Detection of Helicobacter pylori Infection Using Routine Histology, H. pylori Immunohistochemical Stain, and Warthin-Starry Special Stain on Gastric Tissue Biopsy Samples

Abstract Introduction/Objective Helicobacter pylori (HP) is a prevalent cause of gastritis in the US and worldwide. Accurate detection of the organism is important for appropriate treatment. Diagnosis is made using immunohistochemistry and special stains including Warthin-Starry stain (WS) which is low cost, technically easy to perform on tissue sections, and can be automated. We aimed to assess interobserver variability, reproducibility and validity of hematoxylin and eosin stain (H&E), WS and anti-Helicobacter pylori immunohistochemical staining (HP-IHC) for the histopathological identification and evaluation of HP organisms on gastric mucosa biopsies. Methods/Case Report We prospectively evaluated gastric biopsies from ten adult patients. These patients underwent upper gastrointestinal endoscopy with subsequent biopsy for various abdominal complaints. Seven of the ten biopsies (7/10) were HP infection positive, and three cases (3/10) were HP negative by H&E stain and HP-IHC (determined by GI Pathologist). The presence or absence and density of HP, were assessed on H&E, HP-IHC and WS in blinded fashion by five general surgical (GS) pathologists. The GS pathologists assessed the cases for presence and density of HP using the semi-quantitative modified Sydney classification (none, mild, moderate, and severe). Percentage agreement and interobserver variablilty using Cohen-Kappas statistics (KS) were calculated. Results (if a Case Study enter NA) The percentage agreement for presence or absence of HP in the biopsies with H&E, HP-IHC and WS stains were 91%, 98% and 99%, respectively. The interobserver agreement for evaluation of presence of HP was excellent with WS staining method (Overall KS = 0.737 95%, Confidence Interval (CI) = 0.501- 0.973) and HP-IHC (Overall KS = 0.783, 95% CI = 0.585-0.980). Agreement for H&E was moderate (Overall KS = 0.532, 95% CI= 0.392-0.672). HP density agreement was excellent using WS and HP-IHC and H&E was in the moderate range. Conclusion This study found excellent interobserver agreement using IHC and WS. While IHC is the most specific stain, WS is more sensitive in identifying the shape and morphology of HP organisms and is an efficient and low-cost alternative with excellent morphology in general surgical practice.

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Moxifloxacin Based Triple Therapy as Alternative to Standard Therapy in Helicobacter Pylori Eradication.

Anti-Infective Agents ◽

10.2174/2211352518999200925154501 ◽

2020 ◽

Vol 18 ◽

Author(s):

Mohammed Hussien Ahmed ◽

Sherief Abd-Elsalam ◽

Aya Mohammed Mahrous

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Therapy Group ◽

Low Cost ◽

High Rate ◽

Helicobacter Pylori Eradication ◽

Treatment Regimens ◽

Group A ◽

H Pylori ◽

Group B

Introduction: Helicobacter pylori eradication remains a problematic issue. We are in an urgent need for finding a treatment regimen that achieves eradication at a low cost and less side effect. Recent published results showing a high rate of resistance and with clarithromycin-based treatment regimens. The aim of the study was to compare moxifloxacin therapy and classic clarithromycin triple therapy in H. pylori eradication. Methods: This was a pilot study that enrolled 60 patients with helicobacter pylori associated gastritis. Diagnosis was done by assessment of H. pylori Ag in the stool. The patients were randomly assigned to receive either moxifloxacin based therapy (Group A), or clarithromycin based therapy (Group B) for two weeks. We stopped the treatment for another two weeks then reevaluation for cure was done. Results: 90 % of patients had negative H. pylori Ag in the stool after 2 weeks of stoppage of the treatment in group A versus 66.7 % in Group B. None of the patients in both groups had major side effects. Conclusion: Moxifloxacin-based therapy showed higher eradication power and less resistance when compared to clarithromycin triple therapy.

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Characteristics of Helicobacter pylori infection in a National Referral Hospital in Bhutan

Bhutan Health Journal ◽

10.47811/bhj.93 ◽

2020 ◽

Vol 6 (1) ◽

pp. 6-10

Author(s):

Chhabi Lal Adhikari ◽

Guru Prasad Dhakal ◽

Nongluck Suwisith ◽

Sonam Dargay ◽

Krishna P Sharma

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Age Groups ◽

Referral Hospital ◽

Upper Gastrointestinal Endoscopy ◽

Age Group ◽

Exact Test ◽

Significant Difference ◽

H Pylori ◽

National Referral Hospital

Introduction: Helicobacter pylori (H. pylori) is a bacterium causing chronic gastric infection and may cause gastric cancer. It was necessary to see the trend of infection, especially in symptomatic patients. This retrospective descriptive study was aimed to describe the characteristics of H. pylori infection in Bhutanese patients referred for an endoscopy to the National Referral Hospital, Thimphu. Methods: The sample of the study was randomized 380 medical records of the patients who underwent upper gastrointestinal endoscopy and Rapid Urea Test for symptomatic dyspepsia and peptic ulcer. Data was collected using a survey form designed by the researchers. Data analysis was done using descriptive statistics and either Chi-square or Fisher’s exact test. Results: The prevalence of H. pylori infection was very high (76.6%). The mean age of the infection was 42 with a range from 15 to 84 years. The highest prevalence of infection was observed in the age group 20-29 years (82.7%) and lowest in the oldest age group 70-84 years (66.7%). The analysis showed no significant difference in infection amongst age groups, gender, and endoscopic findings to the positive results at 5% significant level except for monthly prevalence (p<0.001). Gastritis was the commonest endoscopy finding (153/380) and gastro-duodenitis had the highest positivity rate (88.9%). Conclusion: The prevalence of infection was relatively high compared with previous studies. Young and middle-aged adults had a high prevalence and this group needs to be given priority for screening and eradication treatment considering limited resources to prevent associated gastric cancer in Bhutan.

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Prevalence of Helicobacter pylori infection among patients undergoing upper gastrointestinal endoscopy

Asian Journal of Health Sciences ◽

10.15419/ajhs.v3i1.405 ◽

2015 ◽

Vol 3 (1) ◽

Author(s):

Vudumula Vijaya Lakshmi

Keyword(s):

Duodenal Ulcer ◽

Helicobacter Pylori ◽

Normal Population ◽

Gastric Ulcers ◽

Upper Gastrointestinal Endoscopy ◽

Contributing Factors ◽

Duodenal Ulcers ◽

Female Ratio ◽

Ulcer Disease ◽

H Pylori

Helicobacter pylori (H. pylori) has a role in the multifactorial etiology of peptic ulcer disease. A link between H. pylori infection and duodenal ulcer disease is now established. Other contributing factors and their interaction with the organism may initiate the ulcerative process. The fact that eradication of H. pylori infection leads to a long-term cure in the majority of duodenal ulcer patients and the fact that the prevalence of infection is higher in ulcer patients than in the normal population are cogent arguments in favor of it being the primary cause of the ulceration. This study was under taken at the Department of surgery, Narayana medical college, Nellore from January 2007 to July 2008. A total of 150 patients with duodenal ulcers, gastric ulcers, antral gastritis, gastric carcinoma and dyspepsia of any kind were studied. Maximum number of cases were in the age group of 31 years to 50 years among both sexes and number of cases gradually decreased after 50 years of age in males and females. Males were more in number and male to female ratio is (2.75:1) approximately 3:1.

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Incidence of gastric cancer, its subtypes, and correlation with Helicobacter Pylori

Journal of Pathology of Nepal ◽

10.3126/jpn.v3i5.7869 ◽

2013 ◽

Vol 3 (5) ◽

pp. 403-407

Author(s):

Shiva Raj KC ◽

GL Amatya ◽

A Lakhey ◽

S Basnet ◽

G Aryal

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Demographic Data ◽

College Teaching ◽

Study Data ◽

Upper Gastrointestinal Endoscopy ◽

Tubular Adenocarcinoma ◽

Common Cause ◽

Medical College ◽

H Pylori

Background: Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer related death worldwide. It is the common cause of cancer related death in Nepal. Helicobacter Pylori has been classified as a definite carcinogen along with other factors. The aim of this study was to fi nd the incidence of gastric cancer among the patients undergoing upper gastroscopy, its various subtypes and association with Helicobacter Pylori. Materials and Methods: This is a retrospective and prospective study carried out at GRP Polyclinic and Kist Medical College Teaching Hospital. All the patients undergoing upper gastrointestinal endoscopy were included in this study. Data of all the gastric endoscopic biopsies done from June 2011 to January 2013 were collected and analyzed. All the biopsy specimens were processed routinely in histopathology laboratory. Specimens showing carcinoma were enrolled in this study and all the relevant demographic data were collected. Results: Out of 3395 biopsy cases; 49 cases (1.44%) were diagnosed as adenocarcinoma stomach. The overall mean age for carcinoma was 47.6 years with a mild male preponderance. Thirty cases (61.2%) were of intestinal type, (n=11; 22.4%) were of diffuse type and (n=8; 16.3%) were mixed type of adenocarcinoma. According to WHO classifi cation the most common subtype was tubular adenocarcinoma (n=35; 71.5%) followed by signet ring type (11 cases; 22.4%). Out of 49 cases of adenocarcinoma stomach 39 cases (79.5%) were Helicobacter Pylori positive. Conclusion: This study shows that gastric carcinoma is a male predominant neoplasm usually of old age but can occur at younger ages. It predominantly occurs in Helicobacter Pylori infected patients and H. Pylori eradication will help to decrease the incidence rate and mortality of stomach cancer. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 403-407 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7869

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Prevalence of dual clarithromycin and metronidazole resistance in Helicobacter pylori estimated by molecular methods in Santiago, Chile

10.1101/236976 ◽

2017 ◽

Author(s):

Patricio Gonzalez-Hormazabal ◽

Maher Musleh ◽

Susana Escandar ◽

Hector Valladares ◽

Enrique Lanzarini ◽

...

Keyword(s):

Helicobacter Pylori ◽

Gastric Mucosa ◽

Initial Approximation ◽

Molecular Methods ◽

University Hospital ◽

Upper Gastrointestinal Endoscopy ◽

Metronidazole Resistance ◽

Two Samples ◽

H Pylori ◽

Upper Gastrointestinal

AbstractBackgroundCurrent available treatments for Helicobacter pylori eradication are chosen according to local clarithromycin and metronidazole resistance prevalence. The aim of this study was to estimate, by means of molecular methods, both clarithromycin and metronidazole resistance in gastric mucosa from patients infected with H.pylori.MethodsA total of 191 DNA samples were analyzed. DNA was purified from gastric mucosa obtained from patients who underwent an upper gastrointestinal endoscopy at an university hospital from Santiago, Chile, between 2011 and 2014. H.pylori was detected by real-time PCR. A 5’exonuclease assay was developed to detect A2142G and A2143G mutations among Hpylori-positive samples. rdxA gene was sequenced in samples harboring A2142G and A2143G mutations in order to detect mutations that potentially confer dual clarithromycin and metronidazole resistance.ResultsNinety-three (93) out of 191 DNA samples obtained from gastric mucosa were H. pylori-positive (48.7%). Clarithromycin-resistance was detected in 29 samples (31.2% [95%CI 22.0%-41.6%]). The sequencing of rdxA gene revealed that two samples harbored truncating mutations in rdxA, one sample had an in-frame deletion, and 11 had amino acid changes that likely cause metronidazole resistance.ConclusionsWe estimated a prevalence of clarithomycin-resistance of 31.8% in Santiago, Chile. The proportion of dual clarithromycin and metronidazole resistance could be, at least, 15.0%. Our results require further confirmation. Nevertheless, they are significant as an initial approximation in re-evaluating the guidelines for H.pylori eradication currently used in Chile.

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GENDER, AGE, ENDOSCOPIC FINDINGS, UREASE AND HELICOBACTER PYLORI: ALL UNCORRELATED WITHIN A SAMPLE OF A HIGH GASTRIC CANCER PREVALENCE POPULATION IN AMAZON

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-50 ◽

2019 ◽

Vol 56 (3) ◽

pp. 264-269

Author(s):

Ariney Costa de MIRANDA ◽

Cássio CALDATO ◽

Mira Nabil SAID ◽

Caio de Souza LEVY ◽

Claudio Eduardo Corrêa TEIXEIRA ◽

...

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Cross Sectional Study ◽

Upper Gastrointestinal Endoscopy ◽

Histopathological Analysis ◽

Rapid Urease Test ◽

Cross Sectional ◽

Cancer Prevalence ◽

Urease Test ◽

H Pylori

ABSTRACT BACKGROUND: It is widely assumed that gender, age, gastritis and Helicobacter pylori , all have some degree of correlation and, therefore, can synergistically lead to the development of gastric cancer. OBJECTIVE: In this cross-sectional study, we expected to observe the above mentioned correlation in the analysis of medical records of 67 patients of both sexes (female, n=44), mean age ± standard deviation: 41±12 years old, all from Belém (capital of Pará State, Brazilian Amazon), a city historically known as one with the highest gastric cancer prevalence in this country. METHODS: All patients were submitted to upper gastrointestinal endoscopy for gastric biopsy histopathological analysis and rapid urease test. All diagnoses of gastritis were recorded considering its topography, category and the degree of inflammatory activity, being associated or not associated with H. pylori infection. RESULTS: The results show that no statistically relevant associations were found among the prevalences of the observed variables. CONCLUSION: The authors hypothesize that observed risk factors associated to gastric cancer might be lesser synergistic than is usually expected.

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Association Between Vitamin D Receptor Gene Polymorphisms and Helicobacter Pylori Infection

The Open Biomarkers Journal ◽

10.2174/1875318302010010008 ◽

2020 ◽

Vol 10 (1) ◽

pp. 8-14

Author(s):

Amal A. Mohamed ◽

Shorouk Moussa ◽

Mahmoud M. Shaheen ◽

Sherief Abd-Elsalam ◽

Rehab Ahmed ◽

...

Keyword(s):

Vitamin D ◽

Helicobacter Pylori ◽

Vitamin D Receptor ◽

Gene Polymorphisms ◽

Gastrointestinal Symptoms ◽

Upper Gastrointestinal Endoscopy ◽

Positive Group ◽

Biopsy Specimens ◽

H Pylori ◽

Upper Gastrointestinal

Background & Aims: Human genetic polymorphism has been reported in the susceptibility and clinical development of infection. In this regard, this study aimed to investigate the link between Vitamin D Receptor (VDR) gene polymorphism and H. pylori infection. Materials and Methods: This cross-sectional study was conducted on 224 adult patients with upper gastrointestinal symptoms who underwent an upper gastrointestinal endoscopy between July 2017 and May 2019 in two major university hospitals. All patients were evaluated for helicobacter pylori infection. Two gastric antral biopsy specimens were taken from each patient. One of those Biopsy specimens was evaluated for histopathology examination and the other one was immersed in a saline solution ready for genomic DNA extraction. Results: There were statistically significant differences between different genotypes of VDR rs7975232 polymorphism between H. pylori infected and non-infected groups (CC was higher in H. pylori negative and AC and AA were the most common in H. pylori positive group). There were statistical differences between different genotypes of VDR rs2228570 between H. pylori infected and non-infected groups (TT was higher in H. pylori negative and CT and CC were the most common in H. pylori positive group). Regarding VDR rs 7975232 gene polymorphisms; the (A) allele was significantly higher H. pylori infected, while (C) allele was significantly higher in uninfected patients. Regarding VDR rs 2228570 gene polymorphisms; the (C) allele was significantly higher H. pylori infected, while (T) allele was significantly higher in uninfected patients. Conclusion: There is a possible association between the FokI and Apal VDR polymorphism and H. pylori infection.

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Thin layer immunoassay; an economical approach to diagnose Helicobacter pylori Infection in gastroduodenal ulcer disease patients of Pakistan; a comparative analysis

10.1101/2020.01.05.895375 ◽

2020 ◽

Author(s):

Faisal Aziz ◽

Yasmeen Taj ◽

Shahana Urooj Kazmi

Keyword(s):

Helicobacter Pylori ◽

Thin Layer ◽

Low Cost ◽

Gastroduodenal Ulcer ◽

Blood Samples ◽

Ulcer Disease ◽

Water Condensation ◽

Condensation Pattern ◽

Polystyrene Plate ◽

H Pylori

AbstractHelicobacter pylori is a causative agent of gastritis, gastroduodenal ulcers and gastric adenocarcinoma. Gastric patient’s serums were screened for H. pylori infection by thin layer immunoassay. A polystyrene plate coated with H. pylori sonicate whole cell antigen (10 μg/ml). Two fold-diluted patient’s serum was allowed to react at 37 °C, incubated at 60 °C for 1 min over water bath and recorded water condensation pattern for H. pylori antibody. Gastric patient’s blood samples (62% male and 6% female) were tested positive for H. pylori, while agewise 15–25 years males (36%) and 65–75 years females (50%) showed highest number of H. pylori infection. Thin layer immunoassay showed sensitivity (72–67%), specificity (100%), accuracy (94–69%) and κ value (0.493–0.357) in comparison with wELISA, sELISA and kELISA. We conclude thin layer immunoassay was reliable, low cost, quick, simple and clinically useful method for H. pylori diagnosis in patients of Pakistan.

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Association of Helicobacter pylori infection with nodular antritis and follicular gastritis

Vojnosanitetski pregled ◽

10.2298/vsp0603313t ◽

2006 ◽

Vol 63 (3) ◽

pp. 313-315 ◽

Cited By ~ 2

Author(s):

Ratko Tomasevic ◽

Gradimir Golubovic ◽

Miroslav Kiurski ◽

Dragana Stankovic ◽

Radoje Doder ◽

...

Keyword(s):

Helicobacter Pylori ◽

Case Report ◽

Chronic Gastritis ◽

Upper Gastrointestinal Endoscopy ◽

Antral Mucosa ◽

Urease Test ◽

Sydney System ◽

H Pylori ◽

The Relationship ◽

Upper Gastrointestinal

Introduction. Helicobacter pylori (H. pylori) infection is known to be the must common cause of chronic gastritis having some endoscopic and pathologic characteristies as determinated by the Sydney System for Gastritis Classification. The aim of our case report was to point out the relationship between an endoscopic finding of nodular antritis and the presence of H. pylori infection and active chronic gastritis. Case report. Our patient underwent upper gastrointestinal endoscopy for dyspeptic complaints and was diagnosed as having nodular antritis, but also underwent urease test and hystopathologic examination of antral mucosa, to determine the presence and density of H. pylori infection and the presence and severity of gastritis. After a course of anti H. pylori treatment, dyspepsia improved and new biopsy specimens obtained two months and six months afterwards revealed no pathological findings. Conclusion. The case report supported the association of H. pylori infection of lymphoid follicles with nodular gastric mucosis.

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Current situation of Helicobacter pylori infection in Indonesia

Medical Journal of Indonesia ◽

10.13181/mji.v25i4.1408 ◽

2017 ◽

Vol 25 (4) ◽

pp. 263-6

Author(s):

Ari F. Syam

Keyword(s):

Helicobacter Pylori ◽

Diagnostic Tests ◽

Low Cost ◽

High Accuracy ◽

Urine Test ◽

Non Invasive ◽

The Past ◽

Genotype Information ◽

H Pylori ◽

Low Prevalence

Data epidemiologi infeksi Helicobacter pylori (H. pylori) terus berubah dalam beberapa dekade terakhir. Indonesia dilaporkan memiliki prevalensi infeksi H. pylori yang rendah dibandingkan dengan negara lain di Asia. Beberapa penelitian di Indonesia melaporkan bahwa sanitasi yang buruk, usia, agama, etnis merupakan faktor risiko untuk infeksi H. pylori. Dibandingkan dengan tes diagnostik lainnya, tes urine merupakan tes yang dapat diandalkan untuk mendeteksi H. pylori di Indonesia karena tes tersebut bersifat non-invasif dengan harga yang cukup terjangkau dan memiliki akurasi yang tinggi. Meskipun banyak penelitian telah dilakukan mengenai prevalensi infeksi H. pylori pada beberapa etnis di Indonesia, peneliti masih memiliki beberapa pertanyaan yang belum terjawab mengenai infeksi H. pylori di Indonesia. Oleh karena itu, diperlukan untuk membangun pusat penelitian H. pylori yang menyediakan fasilitas untuk kultur, evaluasi resistensi antibiotik, dan memperoleh informasi genotipe yang dapat menjelaskan perbedaan dalam infeksi H. pylori di antara berbagai etnis di Indonesia The epidemiology of Helicobacter pylori (H. pylori) has been changing over the past decades. Indonesia was reported have a low prevalence of H. pylori infection compared to other countries in Asia. Some studies in Indonesia have evaluated that poor sanitation, age, religion, ethnicity are the risk factors for H. pylori infection. Compared to other diagnostic tests, the urine test will be reliable for the detection of H. pylori in Indonesia because it is non-invasive and low cost with high accuracy. Although we have already performed studies on the prevalence of H. pylori infection in several ethnics, we still have some questions that remain unclear regarding H. pylori infection in Indonesia. Therefore, we have a need to build a H. pylori center that provide facilities for culturing, evaluating antibiotic resistance, and obtaining the genotype information that may explain the differences in H. pylori infection among ethnic groups in Indonesia.

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