Prevalence of Helicobacter Pylori Infection Among Patients with Dyspepsia by Stool Antigen and Serology Tests

Background: Helicobacter pylori is the most common chronic bacterial infection globally and is the underlying cause of many disorders, including dyspepsia. Also, the prevalence of gastric cancer in Zanjan city is high. Therefore, this study investigates the prevalence of H. pylori infection in patients with dyspepsia by the H. pylori stool antigen (HpSA) test. Materials and Methods: This cross-sectional study was performed on patients over 18 years of age who were referred to Shafieieh Special Clinic in Zanjan with dyspepsia during 2019-2020. First, the HpSA test was examined for H. pylori infection. Since the results of two separate tests are needed to prove that H. pylori infection is negative, the serological test was used in the patients with HpSA negative results. Results: Based on the demographic information of the present study, most patients (70.1%) were under 40 years old, and most (55.1%) were women. Smoking, alcohol, drug, and non-steroidal anti-inflammatory drugs (NSAIDs) use in patients were 16.5%, 6.3%, 7.9%, and 39.4%, respectively. The highest and lowest symptoms were abdominal pain (44.9%) and burp (22%), respectively. Except for the relationship between positive serological results and age (P˂0.001), no significant relationship was found between other variables (P≥0.05). Based on the HpSA test, H. pylori infection was seen in 56.7% of patients. By the serological test, another 29 patients had H. pylori infection. Therefore, the total number of patients was 101, and the overall prevalence of H. pylori increased to 79.5%. Conclusion: The results of the present study showed that the overall prevalence of H. pylori infection was high compared to previous studies. Also, above the age of 40 years, female gender in HpSA test and male gender in serology test, higher education level, and the presence of risk factors (smoking, alcohol, and NSAIDs) have a higher positive test for H. pylori.

Eradication of Helicobacter Pylori with Triple Therapy Comprising Probiotic & Proton Pump Inhibitor

Objectives: The current clinical trial compared the effects of conventional triple therapy and probiotic (Lactobacillus reuteri) plus omeprazole combination in peptic ulcer patients. The secondary objectives included estimating the effects of these regimens on safety and tolerability. Study Design: Randomized clinical trial Abode and Period of Study: This was a six month research study conducted at the National Medical Centre, Karachi, Pakistan in October 2020 – March 2021. Materials & Methods: A total of 100 patients were recruited, had baseline positive stool antigen test. All the participants were separated into dual groups: conventional triple remedy (group A1) and probiotic with omeprazole combination (group B1). The study's primary endpoint was stool antigen assay and secondary included change in Hb, LFTs and renal function test. Results: The primary endpoints for combination therapy led to significantly greater reductions in positive stool antigen assay than triple therapy. This means that combination therapy is far better than triple therapy. The stool antigen test showed 56.5% positive and 43.5% negative in group A1 while in group B1 34.8% positive while 65.2% negative after treatment were seen with statistically significant difference (p=0.036). Insignificant findings were observed for level of Hb, LFTs and renal function test between both groups during the entire study. Conclusion: This is the first randomized clinical trial in peptic ulcer patients of Pakistan treated with probiotic plus omeprazole combination. Combination therapy was generally well-tolerated and effective in eradicating the Helicobacter pylori after initiation of therapy.

Evaluation of the Diagnostic Values and Utility of Helicobacter Pylori Stool Antigen Lateral Immunochromatography Assay

Helicobacter pylori is the most common human gastric infection. H. pylori stool antigen lateral flow immunochromatography assay (HpSA-LFIA) is considered one of the most cost-effective and rapid non-invasive assays (active tests). The evaluation of this test is crucial for accuracy and utility assurance. This study aimed to evaluate the polyclonal antibody-based HpSA-LFIA in comparison to a monoclonal antibody-based ELISA kit. Methodology: Stool samples were collected from 200 gastric patients for HpSA-LFIA and semi-quantitative HpSA-ELISA. Statistical analysis of the diagnostic values was performed using MedCalc software. Chi-square tests were used to determine the effects of gender and age. Results: The obtained results found that HpSA-LFIA achieved promising sensitivity (93.75%) and NPV (98.00%). However, it had poor specificity, PPV, and accuracy, respectively, 59.76%, 31.25%, and 65.31%. LR+ & LR- were 2.33% & 0.1%, respectively. Gender had no significance on the di-agnostic parameters of HpSA-LFIA. Age groups had irrelevant sensitivity; however, specificity was significantly higher in patients over 45 years. Conclusion: It was concluded that HpSA-LFIA was not accurate enough to be the sole test for di-agnosis and needs other confirmatory tests in case of positive conditions

Accuracy of H. pylori fecal antigen test using fecal immunochemical test (FIT)

Background Gastric and colorectal cancer (CRC) are both one of the most common cancers worldwide. In many countries fecal immunochemical tests (FIT)-based CRC screening has been implemented. We investigated if FIT can also be applied for detection of H. pylori, the main risk factor for gastric cancer. Methods This prospective study included participants over 18 years of age referred for urea breath test (UBT). Patients were excluded if they had used antibiotics/bismuth in the past 4 weeks, or a proton pomp inhibitor (PPI) in the past 2 weeks. Participants underwent UBT, ELISA stool antigen test in standard feces tube (SAT), ELISA stool antigen test in FIT tube (Hp-FIT), and blood sampling, and completed a questionnaire on user friendliness. UBT results were used as reference. Results A total of 182 patients were included (37.4% male, median age 52.4 years (IQR 22.4)). Of these, 60 (33.0%) tested H. pylori positive. SAT and Hp-FIT showed comparable overall accuracy 71.1% (95%CI 63.2–78.3) vs. 77.6% (95%CI 70.4–83.8), respectively (p = 0.97). Sensitivity of SAT was 91.8% (95%CI 80.4–97.7) versus 94.2% (95%CI 84.1–98.9) of Hp-FIT (p = 0.98). Serology scored low with an overall accuracy of 49.7% (95%CI 41.7–57.7). Hp-FIT showed the highest overall user convenience. Conclusions FIT can be used with high accuracy and sensitivity for diagnosis of H. pylori and is rated as the most convenient test. Non-invasive Hp-FIT test is highly promising for combined upper and lower gastrointestinal (pre-) cancerous screening. Further research should investigate the clinical implications, benefits and cost-effectiveness of such an approach.

A Comparative Study between Helicobacter Pylori Antigen in Stool with Histopathology and Rapid Urease Test of Endoscopic Biopsy in PUD Patient

Purpose: To assess stool antigen test as an early effective diagnostic tool like other methods for the diagnosis of H. pylori infection in PUD patient. Patients and Methods: This cross-sectional study was carried in a clinical pathology department of a tertiary level hospital. We included all patients with peptic ulcer disease those who were diagnosed by upper GIT endoscopy. Demographic variables and value of laboratory test including Stool antigen test, rapid urease test was studied in this study. Result: A total of eighty-six patients were undergone for endoscopy after tested for Helicobactor pylori antigen in stool. Among 86 study subjects, Male was 56 (65%) and female was 30 (35%). The Mean (±SD) age was found 38.53(±10.40) years with range from 21 to above 60 years. Stool antigen test positive in 66 (66/86, 76.74%), negative in 20 (20/86, 23.3%). Rapid Urease Test positive in 76 (76/86, 88.4%), negative in 20 (20/86, 11.6%). Histopathology positive in 65 (65/86, 75.58%), negative in 21 (21/86, 24.42%). The result was statistically highly significant (P<0.001). Conclusion: Stool antigen test (SAT) is an early effective diagnostic tool like other methods for the diagnosis of H. pylori infection in our country. CBMJ 2020 July: Vol. 09 No. 02 P: 19-25

Prevalence of Helicobacter pylori among Patients with Gastrointestinal Tract (GIT) Symptoms: A Retrospective Study at Selected Africa Air Rescue (AAR) Clinics in Kampala, Uganda, from 2015 to 2019

Background. Helicobacter pylori (HP) infection is extremely common worldwide, with almost half of the world’s population infected. In Uganda, no study has been done on the trends of the prevalence of H. pylori infection in the affluent population. Therefore, this retrospective cross-sectional study aimed at determining the trend of H. pylori prevalence among affluent patients presenting with gastrointestinal (GIT) symptoms whose stool samples were tested at selected AAR clinics in Kampala area. Patients were tested for Helicobacter pylori infection using the stool antigen test between January 2015 and December 2019. Results. The overall 5-year H. pylori prevalence was 35.7% (1298/3634). The prevalence was higher in males (36.0% (736/2044)) than in females (35.4% (562/1590)), although not statistically significant (OR = 0.97, p = 0.680, 95% CI: 0.84–1.11). The prevalence of H. pylori infection was significantly higher (39.4%) among patients who belonged to the age group of 19–35 years (OR = 1.49, p < 0.001 , 95% CI: 1.22–1.82). The prevalence for H. pylori among the age group of 19–35, the most productive age, could be attributed to work-related factors such as stress. The highest prevalence (43.4%) was recorded in 2018 and the lowest (21.4%) in 2015; however, the trend of H. pylori infection in the 5 years was fluctuating. Conclusion. H. pylori infestation is a preserve of not only the poor but also the elites. Stressful factors, especially in the age group of 19–35 years, should be appropriately managed.

Stool Antigen Test is Effective and Sensitive for Detecting Helicobacter Pylori Infection in Bangladeshi Peptic Ulcer Patients

Aims: Helicobacter pylori (H. pylori) is the primary causative agent of peptic ulcer in multiple developing countries, including Bangladesh. This study was designed to investigate the diagnostic value of a rapid immunochromatography-based H. Pylori stool antigen (HpSAg) test to screen H. pylori infection in Bangladeshi population. Methodology and results: A total of 140 suspected peptic ulcer patients who underwent upper gastrointestinal endoscopy at Chittagong Medical College and Hospital, Chattogram, Bangladesh, were included in the study. Histopathology, Rapid Urease Test (RUT), and Microscopic examination of the stained smears were conducted to define H. pylori positive cases. Later, stool antigen detection test was done in H. pylori positive status group, H. pylori negative status group, indeterminate status group, and healthy controls. Out of 140 peptic ulcer suspected patients, 75 (53.6%) patients were confirmed to have peptic ulcer or erosions. Although the proportion of antral erosion was 57.4% in patients who were below 40 years, the proportion decreased to 23.4% in patients over 40 years. Patients over 40 years were mostly suffering from Prepyloric erosion (42.9%). All peptic ulcer patients were also positive on histopathological analysis. However, micorscopic grading of curved bacilli and RUT found 93.3% (70/75) and 89.3% (67/75) patients positive, respectively. High sensitivity (95%), specificity (80%), and diagnostic accuracy (91%) scores for HpSAg assay was obtained in our study. Conclusions, significance and impact of studies: The HpSAg test, for a comparatively less sophisticated assay, can be efficient in detecting the presence of H. pylori pre-and post-therapy and provide more valid test results than other invasive test methods.

Characteristics of endoscopic and pathological findings of amebic colitis

Background The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study was to analyse the characteristics of the endoscopic and pathological findings of amebic colitis and the lessons from our patients, which were useful for diagnosing the amebic colitis timely and avoiding the serious complication. Methods We retrospectively reviewed data of all amebic colitis admitted to Beijing Friendship Hospital from January 2015 to January 2020. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and histological examination, no ELISA stool antigen or PCR tests were used. Results 16 patients were diagnosed with amebic colitis by the colonoscopy accompanied by biopsy and microscopic examination. At first time, 12 (75%) patients were misdiagnosed as IBD. Cecum was the most common site of amebic colitis (100%), and the caecum and rectum were also involved in many lesions (68.75%). Multiple lesions of erosion and/or ulcer were recognized in all patients (100%).The endoscopic findings included multiple irregular shaped ulcers and erosions with surrounding erythema, and the ulcers and erosions were covered by the white or yellow exudates. The intervening mucosae between the ulcers or erosions were normal. The features of rectums can be divided to 2 types: in 6 patients (54.5%), the irregular ulcer or erosions covered with white or yellow exudates were observed in rectum and cecum, and the bloody exudates in rectum were more severe than those in cecum; in other 5 patients (45.5%), rectal lesions were much less severe than those in cecum, the small superficial erosion or reddened mucosa were observed in the rectal ampulla. All patients were diagnosed as detection of amebic trophozoites from HE-stained biopsy specimens. The number of trophozoites ranged from 1/HPF to > 50/HPF. Among 16 cases, mild architectural alteration of colon crypt were observed in 10 cases (62.5%), and serious architectural alteration of colon crypt was found which had crypt branch in 1 case (16.7%). Cryptitis was observed in 12 cases (75%) and its severity was mild or moderate. No crypts abscess was observed in all cases. Conclusions The colonoscopy with histological examination are very important to diagnose the amebic colitis. Detect the amoebic trophozoites in the exudates by histological examination is the vital. Sometimes a negative biopsy does not rule out amebiasis, repeated biopsies may be needed to make the diagnosis.

Stool Antigen Examination as a Diagnostic Tool for Dyspeptic Patient caused by Helicobacter pylori Infection: A Case-based Literature Review

Today, the gold standard for diagnosing H. pylori infection is by Urea Breath Test (UBT). However, UBT tests are not widely available in several remote areas in Indonesia. Stool antigen test (SAT) is an alternative diagnostic test for H. pylori infection. However, it is unclear whether the performance of the SAT to diagnose H. pylori infection can be comparable with UBT accuracy. This report was aimed to determine the accuracy of the stool antigen test (SAT) to diagnose H. pylori infection as an alternative to the urea breath test (UBT). Our case-based literature review indicates that the SAT has high sensitivity (79%-96.4%). Therefore stool antigen tests can help doctors in ruling out H. pylori infection. SAT also demonstrates remarkable specificity of stool antigen examination (98.6%-100%), suggesting that stool antigen tests can help doctors rule in H. pylori infection.