Seroepidemiology of Helicobacter pylori infection in Greece

Detection of Helicobacter pylori: A faster urease test can save resources

AIM: To investigate whether differences in the rapidity of a positive result for Helicobacter pylori can save resources, by comparing two commercially available urease kits.

METHODS: One hundred and eighty-five adults (130 outpatients, 55 inpatients) undergoing gastroscopy were entered prospectively. Patients were divided into two groups: Group 1 (if they were not on PPIs, antibiotics, H₂A, bismuth or sucralfate for up to 14 d prior to the endoscopy) and Group 2 (if they were on, or had been on, any of the above medication in the previous 14 d). At endoscopy two sets of biopsies, taken in random order, were placed in the wells of the Campylobacter-like organism (CLO) test (Kimberly-Clark, Utah, USA) and the Quick test (Biohit Plc, Helsinki, Finland). Five additional gastric biopsies were taken for histology/Giemsa and immunohistochemical study. The two urease test slides were read at 2 min, 30 min, 2 h and 24 h. Sensitivity and specificity at 24 h were determined.

RESULTS: At 24 h, for all patients, there was no difference in sensitivity (100% vs 97.5%), specificity (99.3%), positive (97.5%) and negative predictive values (100% vs 99.3%) between the CLO and Quick tests, respectively. There was a positive result at 30 min in 17/41 (41.5%) CLO tests, and in 28/40 (70%) Quick tests, P = 0.05. Quick test enabled the prescription of eradication therapy before discharge in all 28/40 patients. Only 12 (30%) follow-up appointments were needed. If the CLO test had been used alone, only 17 (41.5%) prescriptions would have been possible prior to discharge and 24 (58%) follow-up appointments would be needed (P = 0.001). Of 2000 gastroscopies performed annually at our unit, a saving of 123 follow-up appointments (total: 8856 Euros or 11 808 USD) would be achieved if we switched to the Quick test.

CONCLUSION: Direct comparison of locally available urease test kits is worthwhile, since the appropriate choice results in a significant saving of resources. Local costs and follow-up protocols will determine the magnitude of these savings.

Helicobacter pylori is a major public health priority in western Balkans: an endoscopy referral center experience

BACKGROUND

Helicobacter pylori infection is a highly prevalent community infection. The prevalence of H.pylori infection has been reported to vary worldwide by geographical area and by social and economic conditions.

AIM

To investigate possible differences regarding the prevalence of H. pylori infection and related gastritis in Greek and Albanian patients undergoing routine endoscopy.

MATERIALS AND METHODS

Single referral endoscopy center retrospective analysis for the period of 2005-2008. For each of the first 101 consecutive Albanian patients, one age and sex matched Greek patient was included. No patient was previously treated for H. pylori. Endoscopic and pathology findings were recorded for H. pylori infection and the presence of active gastritis.

RESULTS

In total 101 Albanians and 101 Greek patients were analyzed. A significantly higher prevalence of H. pylori in Albanians compared to Greeks was observed (54% vs 34%, p=0.005, OR 2.3, 95%CI 1.3-4.0). There were no differences in H. pylori prevalence among sex or age groups. Active gastritis was significantly more frequent in Albanians compared to Greeks (48% vs 32%, p=0.02, OR 2.0, 95%CI 1.3-2.6).

CONCLUSION

This is the first attempt in western Balkans to demonstrate by routine gastroscopy and biopsy that there is a significantly higher prevalence of H. pylori and active gastritis in Albanians as compared to Greeks.

Prevalence of Helicobacter pylori infection among asymptomatic healthy blood donors in Northern Peninsular Malaysia

Helicobacter pylori infection is recognized as being strongly associated with chronic gastritis, duodenal ulceration and, probably, gastric carcinoma. Seroepidemiological studies have shown that a large proportion of healthy people have antibodies against H. pylori. A serological study was conducted in asymptomatic healthy blood donors in Northern Peninsular Malaysia to assess the seropositivity for H. pylori and to investigate the relationship with ethnic group, gender, ABO blood group and age. A total of 5370 serum samples collected from 3677 male and 1693 female donors in different age groups, and who had no gastrointestinal complaints, were studied with an in-house ELISA for the presence of H. pylori IgG and IgA antibodies. Seven hundred and sixty subjects (14.2%) were seropositive. The overall seropositivity did not differ with ethnicity, gender, ABO blood group and age among asymptomatic healthy blood donors in Northern Peninsular Malaysia.

Epidemiology of Helicobacter pylori infection

Helicobacter pylori infection is now recognised as a worldwide problem. It is the most common cause of chronic gastritis, and is strongly linked to peptic ulcer disease and gastric cancer. While the infection is usually acquired in childhood, there is typically a long period of latency with disease manifestations not appearing until adulthood. Gastric cancer does not usually manifest until old age. The infection has a high morbidity rate, but a low mortality rate and is curable with antibiotic therapy.

A comprehensive review of the natural history of Helicobacter pylori infection in children

Across populations of children, Helicobacter pylori prevalence ranges from under 10% to over 80%. Low prevalence occurs in the U.S., Canada, and northern and western Europe; high prevalence occurs in India, Africa, Latin America, and eastern Europe. Risk factors include socioeconomic status, household crowding, ethnicity, migration from high prevalence regions, and infection status of family members. H. pylori infection is not associated with specific symptoms in children; however, it is consistently associated with antral gastritis, although its clinical significance is unclear. Duodenal ulcers associated with H. pylori are seldom seen in children under 10 years of age. H. pylori-infected children demonstrate a chronic, macrophagic, and monocytic inflammatory cell infiltrate and a lack of neutrophils, as compared with the response observed in adults. The effect of H. pylori infection on acid secretion in children remains poorly defined. The events that occur during H. pylori colonization in children should be studied more thoroughly and should include urease activity, motility, chemotaxis, adherence, and downregulation of the host response. The importance of virulence determinants described as relevant for disease during H. pylori infection has not been extensively studied in children. Highly sensitive and specific methods for the detection of H. pylori in children are needed, especially in younger pediatric populations in which colonization is in its early phases. Criteria for the use of eradication treatment in H. pylori-infected children need to be established. Multicenter pediatric studies should focus on the identification of risk factors, which can be used as prognostic indicators for the development of gastroduodenal disease later in life.

ABO blood group, secretor status and detection of Helicobacter pylori among patients with gastric or duodenal ulcers

Patients (454) referred for gastroscopy to the General Hospital of Athens were examined to determine (1) if non-secretors were over-represented among patients with ulcers and (2) if there was an association with ABO blood group or secretor status and carriage of Helicobacter pylori. Compared with the local population, among patients with either gastric ulcer (51) or duodenal ulcer (96) there was a significant increase in the proportion of those who were blood group O (P less than 0.025); however, there were no significant differences in the proportions of non-secretors. H. pylori was identified in 62% of the 454 patients: 59.5% of those without evidence of ulcers; 62.5% of those with gastric ulcer; 88% of those with duodenal ulcer (P less than 0.0005). These bacteria were cultured more often and in higher numbers from patients with duodenal ulcer (P less than 0.025). There was no association between ABO blood group and prevalence of H. pylori. The prevalence of H. pylori among non-secretors with gastric ulcer (12.5%) was significantly lower than that for non-secretors with duodenal ulcer (100%) (P less than 0.0005). This was not observed for secretors.