Combined antrum and corpus biopsy protocol improves Helicobacter pylori culture success

BACKGROUND Helicobacter pylori(H.pylori)causes chronic gastritis,peptic ulcer disease,gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma.Eradication rates have fallen,mainly due to antimicrobial resistance.Consensus guidelines recommend that first-line treatment is based on the local prevalence of antimicrobial resistance and that rescue therapies are guided by antimicrobial susceptibility testing(AST).However,H.pylori culture is challenging and culture-based AST is not routinely performed in the majority of hospitals.Optimisation of H.pylori culture from clinical specimens will enable more widespread AST to determine the most appropriate antimicrobials for H.pylori eradication.AIM To determine whether dual antrum and corpus biopsy sampling is superior to single antrum biopsy sampling for H.pylori culture.METHODS The study received ethical approval from the joint research ethics committee of Tallaght University Hospital and St.James’s Hospital.Patients referred for upper gastrointestinal endoscopy were invited to participate.Biopsies were collected in tubes containing Dent’s transport medium and patient demographics were recorded.Biopsies were used to inoculate Colombia blood agar plates.Plates were incubated under microaerobic conditions and evaluated for the presence of H.pylori.Statistical analyses were performed using Graphpad PRISM.Continuous variables were compared using the two-tailed independent t-test.Categorical variables were compared using the two-tailed Fisher exact test.In all cases,a P value less than 0.05 was considered significant.RESULTS In all,samples from 219 H.pylori-infected patients were analysed in the study.The mean age of recruited patients was 48±14.9 years and 50.7%(n=111)were male.The most common endoscopic finding was gastritis(58.9%;n=129).Gastric ulcer was diagnosed in 4.6%(n=10)of patients,while duodenal ulcer was diagnosed in 2.7%(n=6).Single antrum biopsies were collected from 73 patients,whereas combined antrum and corpus biopsies were collected from 146 patients.There was no significant difference in age,sex or endoscopic findings between the two groups.H.pylori was successfully cultured in a significantly higher number of cases when combined antrum and corpus biopsies were used compared to a single antrum biopsy[64.4%(n=94/146)vs 49.3%(36/73);P=0.04)].CONCLUSION Combined corpus and antrum biopsy sampling improves H.pylori culture success compared to single antrum biopsy sampling.

Shared changes in angiogenic factors across gastrointestinal vascular conditions:A pilot study

BACKGROUND Neovascularisation is common to a variety of gastrointestinal(GI)disorders with differing aetiologies and presentations;usually affecting adults above 60 years.Shared angiogenic factors modulated by disease specific elements could be a common denominator and represent novel diagnostic and therapeutic targets.As yet,assessment of angiogenic factors across several GI vascular disorders associated with recurrent bleeding and anaemia has not been reported.AIM To assess serum levels of angiogenic factors in several intestinal vascular disorders.METHODS A case control study was performed in Tallaght University Hospital in patients with endoscopically proven small bowel angiodysplasia(SBA),portal hypertensive gastropathy(PHG),gastric antral vascular ectasia(GAVE)and nonbleeding,non-anaemic controls.Using enzyme-linked immunosorbent assay,concentrations of Angiopoietin 1(Ang-1),Ang-2 and vascular endothelial growth factor(VEGF)were measured from 2 serum tubes of blood following informed consent.The relative expression of Ang-1 and Ang-2 and Ang-1/2 ratio was calculated and compared between groups.Statistical analysis was applied using a t-test,and a P value of<0.05 was considered significant.RESULTS To date 44 samples were tested:10 SBA,11 PHG,8 GAVE and 15 controls.Mean age 60(range 20-85)years and 20(45%)were males.Controls were significantly younger(49 years vs 66 years,P=0.0005).There was no difference in VEGF levels between the groups(P=0.6).SBA,PHG and GAVE Ang-1 levels were similar and were significantly lower than controls,(P=0.0002,95%CI:241 to 701).Ang-2 levels were statistically higher in PHG and GAVE groups compared to controls(P= 0.01, 95%CI: 77.8 to 668) and as a result, also had a lower Ang-1/2 ratioscompared to controls. While SBA Ang-2 levels were higher than controls, this didnot reach statistical significance. Neither age nor haemoglobin level, which wassimilar between disease groups, could explain the difference. In addition, themedian Ang-1/Ang-2 ratio for all patients was found to be significantly lowercompared to controls, 8 vs 28 respectively, P = 0.001, 95%CI: -27.55 to -7.12.CONCLUSIONOur novel pilot study suggests common alterations in Ang-1 and Ang-2 levelsacross several GI vascular disorders. Differences in Ang-1/Ang-2 ratios amongvascular disorders compared to controls suggest disease-specific modulation.