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Kim JH, Kim JM, Park B, Lim SG, Shin SJ, Lee KM, Lee GH, Noh CK. The Potential Role of the Rapid Urease Test with the Sweeping Method in the Gray Zone of the Urea Breath Test after Helicobacter pylori Eradication. Gut Liver 2025; 19:355-363. [PMID: 40169396 PMCID: PMC12070212 DOI: 10.5009/gnl240470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 01/03/2025] [Accepted: 01/15/2025] [Indexed: 04/03/2025] Open
Abstract
Background/Aims Although the urea breath test (UBT) is widely used as a representative monitoring test after Helicobacter pylori eradication, false-negative results can occur because of the gray zone related to its cutoff value. This study aimed to compare the diagnostic performances of the rapid urease test (RUT), the RUT with sweeping method, and the UBT, and to investigate the role of the sweeping method in the gray zone of UBT values. Methods We retrospectively reviewed 216 patients who received standard first-line H. pylori eradication treatments (n=216). All participants underwent to testing using the sweeping method and UBT on the same day. The sensitivity, specificity, and accuracy were analyzed to compare the two methods. Results The sensitivity (0.537 vs 0.806, p=0.002) and accuracy (0.843 vs 0.870, p=0.026) of the UBT were inferior to those of the sweeping method. A total of 31 individuals tested positive for H. pylori according to the UBT, whereas 54 individuals tested positive according to the sweeping method. In the group for which the gold standard definition indicated H. pylori positivity but UBT results were negative (n=31), all individuals had a UBT value under 2.5‰. In the multivariate logistic regression model, a UBT value of 1.4‰ to 2.5‰ increased the risk of false-negative results by 6.5 times (odds ratio, 6.5; 95% confidence interval, 2.077 to 20.288; p=0.001). Conclusions After H. pylori eradication, false-negative results can occur for individuals undergoing the UBT, primarily for values below the UBT cutoff. The RUT with the sweeping method can potentially help detect H. pylori in the gray zone of the UBT, improving diagnostic accuracy.
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Affiliation(s)
- Ji Hyun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Min Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Gil Ho Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Choong-Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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Dinçer B, Ömeroğlu S, Güven O, Yanar C, Demir U, Akgün İE. Evaluation of Antral Biopsies Obtained in Endoscopically Normal Esophagogastroduodenoscopy: A Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2024; 34:439-443. [PMID: 38957011 DOI: 10.1097/sle.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The requirement for routine biopsy sampling in esophagogastroduodenoscopy (EGD) with normal endoscopic findings is a subject of debate. In this study, patients who had normal endoscopic findings in EGD and underwent biopsy sampling were retrospectively analyzed. METHODS This single-center retrospective cohort study included 671 patients who underwent EGD between 2021 and 2023 in the Sisli Hamidiye Etfal Training and Research Hospital Surgical Endoscopy Unit. All patients had normal endoscopic findings and a sampling biopsy was performed on all patients included. Patients were evaluated based on demographic and clinicopathologic findings. This study was registered to ClinicalTrials.gov (NCT06269380). RESULTS Two hundred sixty patients (38.7%) have abnormal histopathologic findings. Helicobacter pylori positivity was detected in 200 (29.8%) patients. Intestinal metaplasia (IM) was present in 80 of 260 patients (30.8%). The frequency of IM was higher in older age groups and cases with mild gastritis ( P <0.001). The frequency and severity of gastritis were associated with increased H. pylori positivity and density ( P <0.001). CONCLUSIONS The biopsy sampling may contribute to the diagnosis and treatment process in cases where normal endoscopic findings are observed during EGD.
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Affiliation(s)
- Burak Dinçer
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
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Ahmad SO, AlAmr M, Taftafa A, AlMazmomy AM, Alkahmous N, Alharran AM, Almarri AM, Alyaqout F, Saad AR, Alazmi AM, Alharran YM, Abotela M, Abu-Zaid A. Exploring the Relationship Between Helicobacter pylori Infection and Biliary Diseases: A Comprehensive Analysis Using the United States National Inpatient Sample (2016-2020). Cureus 2024; 16:e61238. [PMID: 38939288 PMCID: PMC11210440 DOI: 10.7759/cureus.61238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection is widely recognized for its association with gastric diseases. Prior studies on the relationship between H. pylori infection and biliary diseases have faced constraints, including inadequate control of confounding factors and small sample sizes. This study aims to explore the association between H. pylori infection and biliary diseases using a large, population-based sample with adequate control for various covariates. METHODS The National Inpatient Sample (NIS) from 2016 to 2020 was used to investigate the association between H. pylori infection and biliary diseases. We identified patients with H. pylori infection using the International Classification of Diseases, Tenth Revision (ICD-10) code (B96.81). Descriptive analysis and inferential statistics, including univariate and multivariate regression, were performed to explore the relationship between H. pylori and selected biliary diseases. Results: Overall, 32,966,720 patients were analyzed. Among them, 736,585 patients had biliary diseases (n=1,637 with H. pylori and n=734,948 without H. pylori). The baseline characteristics revealed notable differences in demographics and healthcare variables between both groups. Univariate regression analysis demonstrated significant associations between H. pylori infection and various biliary diseases such as gallbladder stones, gallbladder cancer, cholangitis, acute cholecystitis, and biliary pancreatitis, with the highest risk for chronic cholecystitis (odds ratio: 5.21; 95% confidence interval: 4.1-6.62; p<0.0001). Multivariate regression analysis, after adjusting for various covariates, confirmed these associations, providing insights into the potential causal relationship between H. pylori and biliary diseases. CONCLUSION This study strengthens the evidence suggesting a potential association between H. pylori infection and biliary diseases. The findings need to be validated in prospective clinical studies.
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Affiliation(s)
- Syed O Ahmad
- Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - Mohammad AlAmr
- Department of Family Medicine, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | | | | | | | - Abdullah M Alharran
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | - Abdulhadi M Almarri
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | - Fajer Alyaqout
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | - Abdulbadih R Saad
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | - Abdulaziz M Alazmi
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
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Peng J, Xie J, Liu D, Yang K, Wu S, Liu D, Huang D, Xie Y. Impact of Helicobacter pylori colonization density and depth on gastritis severity. Ann Clin Microbiol Antimicrob 2024; 23:4. [PMID: 38217000 PMCID: PMC10785438 DOI: 10.1186/s12941-024-00666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Helicobacter pylori (H. pylori) infection is the most common etiology of chronic gastric. H. pylori gastritis would gradually evolve into gastric atrophy, intestinal metaplasia, dysplasia and malignant lesions. Herein, this study aimed to investigate the potential impact of H. pylori colonization density and depth on the severity of histological parameters of gastritis. METHODS A prospective monocentric study was conducted from December 2019 to July 2022, enrolling patients with confirmed chronic H. pylori infection via histopathological evaluation. H. pylori colonization status was detected by immunohistochemical staining, pathological changes of gastric specimens were detected by hematoxylin eosin staining. Epidemiological, endoscopic and histopathological data were collected. RESULTS A total of 1120 patients with a mean age of 45.8 years were included. Regardless of the previous history of H. pylori eradication treatment, significant correlations were observed between the density and depth of H. pylori colonization and the intensity of gastritis activity (all P < 0.05). Patients with the lowest level of H. pylori colonization density and depth exhibited the highest level of mild activity. In whole participants and anti-H. pylori treatment-naive participants, H. pylori colonization density and depth were markedly correlated with the severity of chronic gastritis and gastric atrophy (all P < 0.05). H. pylori colonization density (P = 0.001) and depth (P = 0.047) were significantly associated with ulcer formation in patients naive to any anti-H. pylori treatment. No significant associations were observed between the density and depth of H. pylori colonization and other histopathological findings including lymphadenia, lymphoid follicle formation and dysplasia. CONCLUSIONS As the density and depth of H. pylori colonization increased, so did the activity and severity of gastritis, along with an elevated risk of ulcer formation.
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Affiliation(s)
- Jianxiang Peng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Jinliang Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Dingwei Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Kaijie Yang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
- Ganzhou People's Hospital, Ganzhou, Jiangxi Province, China
| | - Shuang Wu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
- The Second People's Hospital of Jingdezhen, Jingdezhen, Jiangxi Province, China
| | - Dongsheng Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Deqiang Huang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China.
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China.
| | - Yong Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, China.
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China.
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Yao B, Xu X, Liu W, Zhang Q, Wang W, Huang Z. The correlation of Th22 and regulatory T cells with Helicobacter pylori infection in patients with chronic gastritis. Immun Inflamm Dis 2023; 11:e768. [PMID: 36705412 PMCID: PMC9846114 DOI: 10.1002/iid3.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/13/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Helicobacter pylori is planted in the human stomach and is the most common cause of chronic gastritis, which produced specific local and systemic humoral immunity, while the associations of these immune responses and H. pylori in the development of chronic gastritis remain unclear. METHODS This study analyzed histology, the number of Th22 and regulatory T (Treg) cells, and the levels of inflammation- and gastritis-related indicators between 22 H. pylori-infected and 24 non-H. pylori-infected chronic gastritis patients by hematoxylin-eosin staining, enzyme-linked immunosorbent assay, quantitative reverse transcription PCR, and flow cytometry analysis. RESULTS This study found that the pathological damage degree of gastric mucosa in H. pylori infection patients was more serious. In the H. pylori-infected patient serum, the gastrin, G-17, interleukins (IL)-22, transforming growth factor (TGF)-β, tumor necrosis factor (TNF)-α, IL-4, and IL-17A levels were notably raised, while the interferon (IFN)-γ level was inhibited, and in gastric mucosa, and except IFN-γ, the IL-22, forkhead box P3 (Foxp3), TNF-α, IL-4, and IL-17A mRNA levels were raised too. The receiver operating characteristic curve analysis indicates serum IL-22, TGF-β, TNF-α, IL-4, and IL-17A are suitable for differential diagnosis of H. pylori infection. In addition, in the peripheral blood, the percentages of the IL-22+ CD4+ and Foxp3+ CD4+ T cells were raised with H. pylori infection. The positive correlation between IL-22 and Foxp3 mRNA levels and the degree of H. pylori colonization and gastric mucositis by Pearson's correlation analysis. CONCLUSIONS Treg and Th22 cells were positively associated with the degree of H. pylori infection and the severity of gastritis. In summary, this study provides an experimental basis for the study of the eradication of H. pylori and the biological mechanism of chronic gastritis.
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Affiliation(s)
- Biyu Yao
- Department of GastroenterologyPeople's Hospital of YuhuanZhejiangTaizhouChina
| | - Xiaoyan Xu
- Department of GastroenterologyPeople's Hospital of YuhuanZhejiangTaizhouChina
| | - Weijie Liu
- Department of GastroenterologyPeople's Hospital of YuhuanZhejiangTaizhouChina
| | - Qin Zhang
- Department of GastroenterologyPeople's Hospital of YuhuanZhejiangTaizhouChina
| | - Wei Wang
- Department of GastroenterologyPeople's Hospital of YuhuanZhejiangTaizhouChina
| | - Zhiming Huang
- Department of GastroenterologyThe First Affiliated Hospital of Wenzhou Medical UniversityZhejiangWenzhouChina
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