Dual specimens increase the diagnostic accuracy and reduce the reaction duration of rapid urease test

AIM:To evaluate the influence of multiple samplings during esophagogastr oduodenoscopy(EGD) on the accuracy of the rapid urease test,and the validity of newly developed rapid urease tests,HelicotecUT plus test and HelicotecUT test,CLO test and ProntoDry test.METHODS:A total of 355 patients undergoing EGD for dyspepsia were included.Their Helicobacter pylori(H.pylori) treatment status was either nave or eradicated.Six biopsy specimens from antrum and gastric body,respectively,were obtained during EGD.Single antral specimens and dual(antrum+body) specimens were compared.Infection status of H.pylori was evaluated by three different tests:culture,histology,and four different commercially available rapid urease tests(RUTs)-including the newly developed HelicotecUT plus test and HelicotecUT test,and established CLO test and ProntoDry test.H.pylori status was defined as positive when the culture was positive or if there were concordant positive results among histology,CLO test and ProntoDry test.RESULTS:When dual specimens were applied,sensitivity was enhanced and RUT reaction time was signif icantly reduced,regardless of their treatment status.Thirty minutes were enough to achieve an agreeable positive rate in all the RUTs.Both newly developed RUTs showed comparable sensitivity,specif icity and accuracy to the established RUTs,regardless of patient treatment status,RUT reaction duration,and EGD biopsy sites.CONCLUSION:Combination of antrum and body biopsy specimens greatly enhances the sensitivity of rapid urease test and reduces the reaction duration to 30 min.

Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of Helicobacter pylori

BACKGROUND Endofaster is an innovative technology that can be combined with upper gastrointestinal endoscopy(UGE)to perform gastric juice analysis and real-time detection of Helicobacter pylori(H.pylori).AIM To assess the diagnostic performance of this technology and its impact on the management of H.pylori in the real-life clinical setting.METHODS Patients undergoing routine UGE were prospectively recruited.Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test(RUT).Gastric juice sampling and analysis was performed using the Endofaster,and the diagnosis of H.pylori was based on real-time ammonium measurements.Histological detection of H.pylori served as the diagnostic gold standard for comparing Endofaster-based H.pylori diagnosis with RUT-based H.pylori detection.RESULTS A total of 198 patients were prospectively enrolled in an H.pylori diagnostic study by Endofasterbased gastric juice analysis(EGJA)during the UGE.Biopsies for RUT and histological assessment were performed on 161 patients(82 men and 79 women,mean age 54.8±19.2 years).H.pylori infection was detected by histology in 47(29.2%)patients.Overall,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value(NPV)for H.pylori diagnosis by EGJA were 91.5%,93.0%,92.6%,84.3%,and 96.4%,respectively.In patients on treatment with proton pump inhibitors,diagnostic sensitivity was reduced by 27.3%,while specificity and NPV were unaffected.EGJA and RUT were comparable in diagnostic performance and highly concordant in H.pylori detection(κ-value=0.85).CONCLUSION Endofaster allows for rapid and highly accurate detection of H.pylori during gastroscopy.This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.

Evaluation of the use of rapid urease test:Pronto Dry to detect H pylori in patients with dyspepsia in several cities in Indonesia

AIM： To evaluate Pronto Dry examination in patients with dyspepsia. METHODS： The study was conducted in patients with dyspepsia who underwent endoscopic examination in several endoscopic centers of several cities in Indonesia from January 2003 until April 2004. Biopsies for histopathologic examination were fixed with formalin and sent to Histopathologic Department to be analyzed and confirm the presence of Hpylori infection. If Hpylori was found positive, the density was calculated semi quantitatively. Histopathologic examination from gastric biopsy samples was interpreted based on the updated Sydney system classification. RESULTS： Of 550 patients, 309 （56%） were male and 241 （44%） were female with ages ranging from 15 to 82 years. Mean age was 44.98 ± 14.46 years. Mean age of male patients was 44.35 ± 13.85 years and mean age of female patients was 45.78± 15.19 years. Evaluation of endoscopic results showed gastric ulcer in 36 cases （6.5%） and duodenal ulcer in 20 cases （3.6%）. Normal endoscopic finding was found in 45 cases （8.2%） and minimal disorder of gastritis and duodenitis were found in 246 cases （44.7%）. One case of gastric cancer was identified. Of 56 cases which were positive based on the criteria used, 39 patients were positive with Pronto Dry and 17 patients were negative with Pronto Dry. Overall sensitivity and specificity of Pronto Dry were 69.7% and 95.7% respectively. Positive predictive value was 66.1% and negative predictive value was 96.4% and overall accurate rate was 92.9%. CONCLUSION： Pronto Dry seems promising as a diagnostic tool to detect Hpy/ori more rapidly and accurately.

Rapid Urease Test and Faecal Antigen Detection for Rapid Diagnosis of Helicobacter pylori Infection in Dyspepsia

Background: Helicobacter pylori (H. pylori) is considered as one of the most prevalent gastric infections which cause chronic gastritis and predispose to cancer stomach. So, diagnosis and eradication should be rapid to decrease the risk of gastric cancer. Aim of the study: To evaluate the role of rapid urease test (RUT) and faecal antigen test (FAT) added to serological test for rapid diagnosis of active H. pylori infection. Patients and methods: 270 patients with dyspepsia and positive serology for H. pylori infection were included. Two antral and two corporal gastric biopsies were taken for RUT and Histopathological examination. Fresh stool samples were obtained from all patients for FAT. Results: The mean age of the studied patients was 45 ± 25. H. pylori infection was found in 256 (94.8%) of the included patients: 236 (92.18%) with positive all tests, 5 (1.95%) with positive both RUT and FAT, 8 (3.12%) with positive both histology and RUT and 7 (2.73%) with positive histology and FAT. The sensitivity, specificity and positive predictive values for RUT were as follows: 97.27%, 85.71% and 99.20% respectively and 96.88%, 85.71% and 99.20% respectively for FAT. Conclusions: RUT or FAT in patients with positive serological test could be used for rapid diagnosis of active H. pylori infection with good sensitivity and specificity without waiting for the results of histology or culture.

Value of a new stick-type rapid urine test for the diagnosis of Helicobacter pylori infection in the Vietnamese population

AIM: To assess the value of a new test for the diagnosis of Helicobacter pylori (H. pylori) infection, Rapirun®H. pylori Antibody Stick (Rapirun® Stick), in a Vietnamese population.

Retrospective analysis of discordant results between histology and other clinical diagnostic tests on helicobacter pylori infection

BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.

幽门螺旋杆菌感染检测:快速尿酶法(RUT)和银染法(W-S)的比较

目的:快速尿酶法(rapid urease test,RUT)是一种快速、简便的幽门螺旋杆菌(Helicobacter pylori,Hp)检测方法,将其与病理诊断中传统的银染法(W-S)进行比较,通过对比二者的阳性率,以传统银染法(W-S)的阳性率为基准,判断快速尿酶法(RUT)是否能在临床诊断中发挥更好的作用,使Hp感染患者能够得到及时的确诊和治疗。方法:选取2012年8月至2013年8月期间,未使用过抗生素、质子泵抑制剂、H2受体阻滞剂等可能影响Hp检测结果药物的患者164例,同步完成快速尿酶法(RUT)和银染法(W-S)检测,对比快速尿酶法(RUT)和银染法(W-S)的阳性率。结果:快速尿酶法(RUT)的阳性率(35.37%)略高于银染法(W-S)的阳性率(32.32%)。结论:快速尿酶法(RUT)操作便捷,但容易受到诸多不稳定因素的影响,更适合Hp感染的初筛。银染法(W-S)操作相对复杂,但病理诊断结果具有更高的准确性,更适合作为Hp感染最终的确诊手段。

口腔与胃幽门螺杆菌检测结果分析

目的:分析口腔与胃中幽门螺杆菌的检测结果,证明口腔HP可能是胃HP的一个重要储菌池。方法:采用快速尿素酶试验和14C尿素呼气试验相结合的方法,对132例OLP患者行口腔和胃黏膜幽门螺杆菌感染检测。结果:在OLP患者中,不论有无慢性胃病史,患者口腔幽门螺杆菌感染率均明显高于胃内幽门螺杆菌感染率;有慢性胃病史的患者,胃和口腔中幽门螺杆菌感染率为76.19%和96.83%;无慢性胃病史的患者,胃和口腔中幽门螺杆菌感染率为31.88%和57.97%。结论:口腔HP与胃HP感染密切相关,它可能是胃HP的一个重要储菌池。

2型糖尿病对Hp根除率的影响

目的 研究 2型糖尿病 (DM)对幽门螺杆菌 (Hp)根除率的影响。方法 将活体组织检查Hp阳性的患者作为研究对象 ,其中 80例为 2型DM患者 (DM组 ) ,80例为胃肠病门诊确诊的非DM消化不良的患者 (对照组 )。按相同方法对两组患者进行活检和治疗。两组患者均给予阿莫西林 (1g ,2次 /d)、克拉霉素 (0 5 g ,2次 /d)和奥美拉唑 (2 0mg,2次 /d)三联用药治疗 10d。抗Hp治疗 6周后 ,通过胃镜取胃体、胃窦部的活体组织进行复查 ,没有再发现Hp感染者为治愈。结果 DM组与对照组的Hp根除率分别为 5 0 %与 85 % ,差别具有显著性意义 (P <0 0 0 1) ;Hp感染的 2型DM患者抗Hp根除治疗前、后胃肠道症状发生率间差别有显著性意义 (P <0 0 5 )。结论 2型DM患者Hp根除率明显低于对照组 ,可能是因DM患者胃部微血管发生病变和频繁使用抗生素产生二重感染 。

^(13)碳-尿素呼气试验评价尿素酶试验诊断幽门螺杆菌的价值

目的应用13碳-尿素呼气试验(13C-UBT)评估快速尿素酶试验诊断幽门螺杆菌(HP)的价值。方法选择胃镜活检组织快速尿素酶试验HP阴性的胃肠道疾病患者,行13C-UBT检测,并以非胃肠道疾病患者为对照。13C-UBT检查HP阳性病例分三组分别施行质子泵抑制剂(PPI)三联、PPI二联和单纯PPI治疗,治疗后复查13C-UBT,作为评价疗效指标。结果768例快速尿素酶试验HP阴性的患者中,460例13C-UBT结果为HP阳性,阳性率59.9%。对13C-UBT检测HP阳性病例三种治疗后转阴率分别为83.6%,16.4%和3.8%,组间差异显著(P<0.05)。结论对于胃镜胃黏膜组织快速尿素酶试验显示HP阴性的病例,应用13C-UBT有助于提高HP检出率和判断HP根除治疗效果。

幽门螺杆菌导致宫颈癌的病因学研究

目的探讨幽门螺杆菌与宫颈癌的病因学相关性研究。方法快速Hp.尿素酶检测法。结果幽门螺杆菌感染阳性患者为32例,感染率较高的是宫颈慢性炎症(18/32)(P<0.05),其中宫颈Ⅱ°糜烂最高(11/32);宫颈癌患者中幽门螺杆菌感染阳性患者为4例(P<0.05),均为鳞癌患者;幽门螺杆菌感染阳性最高的年龄组是40～60岁组(8/32)(P<0.05)。所有感染者除了1例是农村患者,其余均为城市感染者。结论该项研究显示幽门螺杆菌感染可能是宫颈癌发生的原因之一。因此,对幽门螺杆菌慢性感染和传播在宫颈由慢性炎性糜烂导致癌变的过程中所起的作用需要进一步进行研究。

3种方法检测口腔中幽门螺杆菌的效果

目的比较快速尿素酶、多聚酶链反应(PCR)及细菌培养法检测胃炎或消化性溃疡患者口腔中的幽门螺杆菌(Hp)的效果。方法选取经胃镜证实为慢性胃炎或消化性溃疡的患者50例,在磨牙区刮取3份龈下菌斑,分别采用快速尿素酶、PCR、细菌培养法测定Hp。结果快速尿素酶、PCR、细菌培养法的Hp阳性率分别为80%、64%、26%,3种方法比较差异有统计学意义(P<0.05)。结论快速尿素酶、PCR、细菌培养法检测口腔中Hp有明显差异性,其中PCR法不仅特异敏感,而且速度较快、准确率高,是县及县以上医院较好的检测口腔中Hp的方法。

幽门螺杆菌感染对患儿胃黏液蛋白表达的影响

目的探讨幽门螺杆菌（Hp）感染患儿胃黏液蛋白MUC5AC和MUC6的表达。方法2005年1月-2006年6月对有反复腹痛、恶心、呕吐、腹胀、嗳气、纳差等消化道表现,临床诊断为慢性胃炎、消化性溃疡等而行胃镜检查的66例患儿。男39例,女27例;年龄（8.8±3.0）岁。以快速尿素酶试验及Hp-PCR检测Hp感染,并根据Hp感染与否分为Hp感染组和非Hp感染组。HE染色对其进行病理学检测,用RT-PCR检测其胃黏液蛋白MUC5AC和MUC6 mRNA水平。用t及χ^2检验进行组间分析,P〈0.05为有统计学意义。结果Hp阳性39例,感染率为59.09%。其中男26例（66.67%）,女13例（48.15%）,男女比较无显著性差异（χ^2=2.26 P〉0.05）。Hp感染阳性1～6岁4例（33.33%）,〉6～9岁12例（52.17%）,〉9～14岁23例（74.19%）,各年龄段比较有显著差异（χ^2=6.67%P〈0.05）。Hp阳性患儿病理组织学检查表明,其炎性反应程度及炎性反应活动度均较无Hp感染患儿重。主要表现为上皮细胞变性,小凹上皮细胞增生,固有膜炎性反应细胞浸润。炎性反应细胞主要为淋巴细胞和浆细胞。Hp感染组MUC5AC mRNA水平明显低于非Hp感染组;Hp感染组MUC6 mRNA水平高于非Hp感染组。结论儿童Hp感染可使其胃黏膜MUC5AC水平下调及MUC6水平上调,使胃黏液蛋白保护作用减弱,导致胃黏膜炎性反应程度及炎性反应活动度加重。

血清学检测在快速尿素酶试验假阴性出血性溃疡患者中的诊断价值

目的观察快速尿素酶试验（RUT）在出血性消化性溃疡患者中敏感性,探讨血清学检测（免疫印迹法,IBT）能否提高RUT假阴性消化性溃疡并出血患者H.pylori感染检出率。方法采用RUT、组织学（W-S染色法）和IBT三种方法检测2009年1月~8月经胃镜确诊的39例出血性消化性溃疡（出血组）住院患者H.pylori感染情况与33例非出血性消化性溃疡（非出血组）门诊患者进行对照研究。以最少两种诊断方法阳性为H.pylori感染诊断参照标准。结果RUT在出血组H.pylori阳性率43.6%低于非出血组81.8%（P=0.001）,差异有统计学意义。出血组IBT阳性率87.2%明显高于RUT阳性率43.6%（P〈0.001）;也高于W-S染色法阳性率64.1%,差异有统计学意义（P=0.012）。出血组RUT灵敏度65.4%显著低于非出血组96.3%（P=0.005）。出血组RUT阴性患者22例,依参照标准IBT可检出RUT假阴性患者9例,在出血性消化性溃疡RUT阴性患者中H.pylori检出率为40.9%。结论RUT在出血性消化性溃疡患者中灵敏度降低,假阴性患者增加。血清学（IBT）可作为H.pylori感染出血性消化性溃疡RUT阴性患者的补救措施或可选方法之一,有助于提高消化性溃疡并出血时H.pylori感染检出率。

幽门螺杆菌感染的检测方法比较

目的为简便、快速又无创伤性地确定幽门螺杆菌（HP）感染，对HP感染的检测方法进行比较。方法采用胃粘膜HP快速尿素酶试验、胃粘膜HP培养、血清抗HP抗体检测、同位素13C尿素呼气试验（13C－UBT）的方法，对213例有上消化遗症状儿进行HP检测。结果胃粘膜HP快速尿素酶试验、血清抗HP抗体检测及13C－UBT的结果均相似；血清抗HP抗体检测结果的阳性率明显高于胃粘膜HP培养的阳性率。结论可用血清抗HP抗体检测代替胃粘膜HP快速尿素酶试验，以减少患儿行内镜检查的痛苦，并能减少Hp横向传播的可能性。13C－UBT阳性提示Hp现症感染，而血清抗Hp抗体检测阳性，则提示Hp感染后一段时间内的体内抗体水平，二者不能替代。

反流性食管炎与幽门螺杆菌感染关系的探讨

目的 :探讨反流性食管炎与幽门螺杆菌感染的关系。方法 :选取胃镜诊断为食管炎的病人 14 88例 ,根据食管炎的Tytagat内镜分级将其分为Ⅰ～Ⅴ五级 ;取胃黏膜组织 ,用HP检测试纸行快速尿素酶测定 ,对照组慢性胃炎的病人 16 0 0例 ;消化性溃疡的病人 16 0 0例。结果 :反流性食管炎组幽门螺杆菌感染率 6 3.0 4 %。胃炎组感染率 6 5 .15 % ,同反流性食管炎组相比无差异 (P >0 .0 5 )。溃疡组感染率为 74 .5 0 % (P <0 .0 1)。Ⅰ～Ⅴ级反流性食管炎中反流性食管炎愈重HP检出率愈低(P <0 .0 1) ;反流性食管炎严重程度同HP感染严重程度成负相关 (P <0 .0 1)。结论 :1)幽门螺杆菌感染同反流性食管炎发病的关系尚有争议。 2 )幽门螺杆菌在反流性食管炎的发病过程中起着保护的作用。 3)反流性食管炎患者抗幽门螺杆菌的治疗应在反流性食管炎经治疗后症状消失而药物未停的情况下 ,谨慎进行。

胃组织活检幽门螺旋杆菌检测方法比较

目的分析比较四种胃活检幽门螺旋杆菌(Helicobacter pylori,H.pylori)检测方法,旨在找出一种敏感性,特异性高且操作便捷的检测方法.方法选取490例胃黏膜活检组织标本,采用快速尿激酶法(rapidureasetest,RUT)、荧光定量聚合酶链反应(fluorescence quantitative polymerase chain reaction,q PCR)、硼酸亚甲蓝法和免疫组织化学法(immunohistochemistry,IHC)进行检测,观察H.pylori的显示情况,对阳性率进行χ2检验.结果 RUT、q PCR、硼酸亚甲蓝法和IHC在490例标本中的H. pylori阳性检出率分别为18.98%、63.88%、32.04%和38.16%,差异具有统计学意义(P <0.005).结论 IHC检测H. pylori阳性组织,镜检为H. pylori呈黄褐色而周围胃黏膜组织细胞核呈蓝色,对比强烈,更为直观,有助于实验者获取具有潜在临床应用价值的形态学信息,且实验操作对仪器、实验人员无特殊要求.故建议将IHC检测胃活检H. pylori作为指导临床诊断H. pylori感染、实行H. pylori除菌治疗和疗效判断的依据之一.

幽门螺杆菌感染与胃黏膜上皮不典型增生的关系

目的研究幽门螺杆菌(Helicobacterpylori,Hp)感染与胃黏膜上皮不典型增生的关系。方法检测病例胃黏膜上皮组织中Hp感染(快速尿素酶试验和Giemsa染色)及不典型增生的情况。结果473例胃黏膜上皮组织中,Hp阳性322例(68.1%),不典型增生49例(10.3%)。在Hp感染组中,不典型增生37例(11.5%),非感染组中则为12例(7.9%),二者之间差异显著(P<0.05)。另外,在HP感染组中,不典型增生的程度随着Hp感染分级的增加而增加。结论胃粘膜上皮不典型增生与幽门螺杆菌感染有关,且有随之增加而增加的趋势。

^(14)C呼气试验与快速尿素酶试验检测幽门螺杆菌感染的对比研究

目的:探讨14C呼气试验和快速尿素酶试验两种方法对幽门螺杆菌(H.pylori)感染的诊断价值。方法:107例有消化道症状的患者,分别用14C呼气试验和快速尿素酶试验两种方法进行检测,比较两种方法对H.pylori检测符合率及灵敏度、特异度、阳性预测值和阴性预测值。结果:两种方法对H.pylori感染的检出率分别为92.0%和89.8%,但差异无统计学意义。14C呼气试验的灵敏度、特异度、阳性预测值和阴性预测值分别为92.7%、88.0%、93.8%和84.6%。快速尿素酶试验灵敏度、特异度、阳性预测值和阴性预测值分别为87.8%、80.0%、91.1%和71.4%。结论:14C呼气试验和快速尿素酶试验对H.pylori感染的诊断均有很高的敏感性和特异性,是临床上用于H.pylori感染诊断的可靠方法。

幽门螺杆菌感染三种诊断方法的分析评价

目的 :对幽门螺杆菌 (Hp)感染的三种临床诊断方法——病理组织学、血清学、快速尿素酶试验的敏感性、特异性、有效性、阳性预测值及阴性预测值进行分析评价。方法 :对 186例因上腹不适的病人进行胃镜检查并取胃粘膜组织作快速尿素酶试验及病理组织学检查 Hp,同时抽血做血清抗幽门螺杆菌抗体测定 ,其中二项阳性认为有 Hp感染。结果 :病理组织学、血清学、快速尿素酶试验的敏感性分别为 81.8% ,93.5 % ,84.6 % ;特异性分别为 96 .7% ,83.7% ,81.4% ;有效性分别为 85 .5 % ,90 .9% ,84.9% ;阳性预测值分别为 98.2 % ,94.1% ,92 .9% ;阴性预测值分别为 6 5 .3% ,82 .0 % ,6 7.8%。结论 :三种方法均有较高的敏感性、特异性及有效性 ,尤以病理组织学特异性最高。对于 Hp的诊断参考 ,在一般临床工作中可任选其中一种。