Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers

AIM: Helicobacter pylori (H pylon) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma. Conventional invasive tests are less sensitive than non-invasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosai polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers. METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test, histology, bacterial culture and mucosai polymerase chain reaction fordetecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosai polymerase chain reaction of H pylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2), iceA1, iceA2. and cag A. RESULTS: Between October 2000 and April 2002,88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/ females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%) and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity, positive predictive value and diagnostic accuracy of mucosai polymerase reaction for H pylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79% and 81%) than in patients with non-bleeding peptic ulcers (99%, 99% and 98%) (P<0.001, P<0.01 and P<0.001 respectively). The sensitivity, negative predictive value and diagnostic accuracy of mucosal polymerase reaction for H py/ori were significantly lower in patients with bleeding peptic ulcers (84%, 83% and 81%) than in patients with chronic gastritis (100%, 100% and 100%) (P= 0.02, P= 0.02 and P=0.001). CONCLUSION: Mucosal polymerase chain reaction for detecting H pylori infection is not reliable in patients with bleeding peptic ulcers.

Polymerase chain reaction-based tests for detecting Helicobacter pylori clarithromycin resistance in stool samples: A meta-analysis

BACKGROUND Helicobacter pylori(H.pylori)infection is closely associated with the etiology of a variety of gastric diseases.The effective eradication of H.pylori infection has been shown to reduce the incidence of gastric carcinoma.However,the rate of H.pylori eradication has significantly declined due to its increasing resistance to antibiotics,especially to clarithromycin.Therefore,the detection of clarithromycin resistance is necessary prior to the treatment of H.pylori.Although many studies have been conducted on the use of polymerase chain reaction(PCR)-based tests to detect clarithromycin resistance in stool samples,no accurate data on the feasibility of these tests are available.Here,we performed a meta-analysis to assess the feasibility of these noninvasive tests.AIM To evaluate the reliability of PCR-based tests for detecting H.pylori clarithromycin resistance in stool samples.METHODS We searched PubMed,Medline,Embase,and other databases for articles that evaluated the value of the PCR analysis of stool samples for detecting the resistance of H.pylori to clarithromycin.We collected cross-sectional studies that met the inclusion criteria.Diagnostic accuracy measures were pooled using a random-effects model.The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.Subgroup analysis was also conducted according to PCR type,purification technique,reference standard,mutation site,sample weight,number of patients,and age group,and the clinical utility of diagnostic tests was evaluated using the Likelihood Ratio Scatter Graph.RESULTS Out of the 1818 identified studies,only 11 met the eligibility criteria,with a total of 592 patients assessed.A meta-analysis of the random-effect model showed that PCR-based analysis of stool samples had high diagnostic accuracy for detecting clarithromycin resistance in patients infected with H.pylori.The combined sensitivity was 0.91[95%confidence interval(CI):0.83-0.95],Q=30.34,and I2=67.04,and the combined specificity was 0.97(95%CI:0.62-1.00),Q=279.54,and I2=96.42.The likelihood ratio for a positive test was 33.25(95%CI:1.69-652.77),and that for a negative test was 0.10(95%CI:0.05-0.18),with an area under the curve of 0.94.The diagnostic odds ratio was 347.68(95%CI:17.29-6991.26).There was significant statistical heterogeneity,and the sub-analyses showed significant differences in the number of patients,sample weight,purification methods,PCR types,mutation points,and reference standards.The included studies showed no risk of publication bias.CONCLUSION PCR-based tests on stool samples have high diagnostic accuracy for detecting H.pylori clarithromycin resistance.

Detection and amplification of Helicobacter pylori urease gene A in gastric biopsies by using nested polymerase (?)hain reaction

A nested polymerase chain reaction(N-PCR)for the spegific detection of Helicobacterpylori(H.pylori)was developed with two primer pairs(nested primers)derived from ureasegene A of H.pylori.The N-PCR was used to detect 21 different samples of H.pylori including20 clinical isolates and 1 reference strain NCTC 14126,but it was negative for other bacterialspecies,showing the N-PCR assay to be 100% specific.Tenfold serial dilution experiments re-vealed the detection of as little as 0.1 fg of H.pylori DNA by N-PCR.To evaluate the PCR as-say for clinical samples,gastric biopsies were tested with N-PCR,and the results were comparedwith those of culture,urease test and histologic examination(reference standard,RS).In 30biopsy specimens,H.pylori DNA sequences were detected by PCR in all of 20(100%)positivetissue and none of the 10 negative tissues.PCR is a specific and sensitive method that can detectthe presence of H.pylori without the need for culture and would have significant importance di-agnostically and epidemiologically.

Helicobacter pylori vacA genotypes and cagA status and their relationship to associated diseases

Helicobacter pylori (H. pylori ) is a major causativebacterium of chronic gastritis, peptic ulcer and mucosaassociated lymphoid tissue lymphoma in humans, and associated with an increased risk of gastric cancer[1 -8]. An important virulant factor of H. pylori is the vacuolating cytotoxin ( VacA ) encoded by vacA that induces cytoplasmic vacuolation in target cells both in vitro and in vivo[9-11]. VacA is produced as a 140 kDa precursor which contains an N-terminal signal peptide and an approximately 33 kDa C-terminal outer membrance exporter. The precursor is cleaved at both N-terminal and C-terminal and secreted into the extracellular milieu as a 95 kDa mature protein. The mature protein futher undergoes specific cleavage to yield 37 kDa and 58 kDa subunits[12-14] Although vacA is present in all H. pylori strains, only about 50% to 60% of strains can induce vacuolation of epithelial cells as assessed by the HeLa cell assay. vacA shows considerable genetic variation in H. pylori isolated from all over the world and contains at least two variable regions. The s region exists as sl or s2 allelic types. Among type sl strains, subtypes sla and slb have been identified. The m region occurs as ml or m2 allelic types. Specific vacA genotype of H. pylori strains are associated with the production of the cytotoxin in vitro, epithelial damage in vivo, and clinical consequences[15-27]. The other virulant factor is the cytotoxin-associated protein (CagA) encoded by the cytotoxin-associated gene (cagA). The cagA gene is present in about 60% to 70% of strains and all of these strains express the cagA. The presence of cagA is also associated with the production of the cytotoxin in vitro, and clinical outcome[24-30]. The aim of this study was (i) to identify vacA genotypes and cagA status of H. pylori isolated from Chinese patients; (ii) to evaluation the relatioship beween vacA genotypes, cagA status and related gastroenterological disorders.

Influence of efflux pump inhibitors on the multidrug resistance of Helicobacter pylori

AIM:To evaluate the effect of efflux pump inhibitors (EPIs) on multidrug resistance of Helicobacter pylori (H. pylori).METHODS: H. pylori strains were isolated and cultured on Brucella agar plates with 10% sheep's blood. The multidrug resistant (MDR) H. pylori were obtained with the inducer chloramphenicol by repeated doubling of the concentration until no colony was seen, then the susceptibilities of the MDR strains and their parents to 9 antibiotics were assessed with agar dilution tests. The present study included periods before and after the advent of the EPIs, carbonyl cyanide m-chlorophenyl hydrazone (CCCP), reserpine and pantoprazole), and the minimum inhibitory concentrations (MICs) were determined accordingly. In the same way, the effects of 5 proton pump inhibitors (PPIs), used in treatment of H. pylori infection, on MICs of antibiotics were evaluated.RESULTS: Four strains of MDR H. pylori were induced successfully, and the antibiotic susceptibilities of MDR strains were partly restored by CCCP and pantoprazole, but there was little effect of reserpine. Rabeprazole was the most effective of the 5 PPIs which could decrease the MICs of antibiotics for MDR H. pylori significantly.CONCLUSION: In vitro, some EPIs can strengthen the activities of different antibiotics which are the putative substrates of the efflux pump system in H. pylori.

Diagnosis of Helicobacter pylori : What should be the gold standard?

Since the discovery of Helicobacter pylori (H. pylori) in 1983, numerous detection methods for the presence of the bacterium have been developed. Each one of them has been associated with advantages and disadvantages. Noninvasive tests such as serology, 13C urea breath test (UBT) and stool antigen tests are usually preferred by the clinicians. Serology has its own limitation especially in endemic areas while 13C UBT is technically very demanding. The stool antigen detection method, although specific, is usually associated with poor sensitivity. The 13C UBT is believed to be specific, but with present revelation of the fact that stomach is colonized by many other urease producing bacteria makes it questionable. Histology, culture, rapid urease test and polymerase chain reaction (PCR) are the tests which are carried out on antral biopsies collected by invasive means. Histology has been proposed to be very sensitive and specific but the question is how by simply looking the morphology of the bacteria in the microscope, one can claim that the curved bacterium is exclusively H. pylori. Rapid urease test (RUT), the doctor’s test, is also challenged because the presence of other urease producing bacteria in the stomach cannot be denied. Moreover, RUT has been reported with poor sensitivity specially, when density of the bacterium is low. Isolation of H. pylori is essential to investigate its growth requirements, antibiotic susceptibility testing, studying virulence factor to develop vaccine and many more explorations. It has also got several disadvantages i.e., special condition for transporting, media, incubation and few days waiting for the colonies to appear, apart from the speed essentially needed to process the specimens. Till date, majority of the microbiological laboratories in the world are not equipped and trained to isolate such fastidious bacterium. The option left is PCR methods to detect H. pylori’s DNA in gastric mucosa, gastric juice, saliva, dental plaques and environmental specimens. There are speculations for false positivity due to detection of non-pylori Helicobacters due to genetic sharing; and false negativity due to low bacterial counts and presence of PCR inhibitors. However, specimen collection, transportation and processing do not require speed and special conditions. PCR based diagnosis may be considered as gold standard by designing primers extremely specific to H. pylori and targeting at least more than one conserved genes. Similarly specificity of PCR may be improved by use of internal Primers. Further, nested PCR will take care of false negatives by countering the effect of PCR inhibitors and low bacterial counts. Therefore, nested PCR based methods if performed properly, may be proposed as gold standard test.

Antimicrobial susceptibility testing for Helicobacter pylori in times of increasing antibiotic resistance

The gram-negative bacterium Helicobacter pylori(H.pylori)causes chronic gastritis,gastric and duodenal ulcers,gastric cancer and mucosa-associated lymphoid tissue lymphoma.Treatment is recommended in all symptomatic patients.The current treatment options for H.pylori infection are outlined in this review in light of the recent challenges in eradication success,largely due to the rapid emergence of antibiotic resistant strains of H.pylori.Antibiotic resistance is a constantly evolving process and numerous studies have shown that the prevalence of H.pylori antibiotic resistance varies significantly from country to country,and even between regions within the same country.In addition,recent data has shown that previous antibiotic use is associated with harbouring antibiotic resistant H.pylori.Local surveillance of antibiotic resistance is warranted to guide clinicians in their choice of therapy.Antimicrobial resistance is assessed by H.pylori culture and antimicrobial susceptibility testing.Recently developed molecular tests offer an attractive alternative to culture and allow for the rapid molecular genetic identification of H.pylori and resistance-associated mutations directly from biopsy samples or bacterial culture material.Accumulating evidence indicates that surveillance of antimicrobial resistance by susceptibility testing is feasible and necessary to inform clinicians in their choice of therapy for management of H.pylori infection.

Clinical significance of PCR in Helicobacter pylori DNA detection in human gastric disorders

AIM To investigate the clinical significance of the PCR assay in the diagnosis of gastric H. pylori infection. METHODS HP infection in gastric antral biopsied specimens was identified by the polymerase chain reaction (PCR) to amplify the specific HP urease gene fragments (PCR HP DNA) in 154 patients with gastrointestinal disorders. HP urease genes oligonucleotide primers specific for HP (16s rRNA) were used. Urease test and ELISA for serum anti HP IgG were also used as control. RESULTS PCR HP DNA was detected in 140(91%) of the 154 patients, 114 and 125 were found infected with HP by urease test and ELISA HP IgG, respectively. There was a marked difference in the HP positive rate between the PCR HP DNA and the urease test or ELISA HP IgG ( P <0 05). The rate of HP infection increased with age although a minority of infected people develop signs and symptoms of gastric disorders. HP infection is closely related to adenocarcinoma in gastric antrum and the downbody of the stomach. CLNCLUSION PCR is a sensitive and specific method for the detection of HP in human gastric tissues. Detection of HP DNA in vivo by this approach might improve the clinical diagnosis and epidemiological research of H. pylori infection.

Polymorphism of flagellin A gene in Helicobacter pylori

AIM:To study the polymorphism of flagellin A genotype and Its significance in Helicobecter pylori(H.pylori). METHODS:As the template,genome DNA was purified from six clinical isolates of H.pylori from outpatients,and the corresponding flagellion A fragments were amplified by polymerase chain reaction.All these products were sequenced.These sequences were compared with each other,and analyzed by software of FASTA program. RESULTS:Spaciflc PCR products were amplified from all of these H.pylorl isolates and no length divergence was found among them.Compared with each other,the highest ungappad identity is 99.10%,while the lowest is 94.65%. Using FASTA program,the alignments between query and llbary sequences derived from different H.pylori strains were higher than 90%. CONCLUSION:The nucleotide sequence of flagellin A in H. pylori is highly conservative with Incident divergence.This Information may be useful for gene diagnosis and further study on flagellar antigen phenotype.

Virulence and potential pathogenicity of coccoid Helicobacter pylori induced by antibiotics

AIM: To explore the virulence and the potential pathogenicity of coccoid Helicobacter pylori (H. pylori) transformed from spiral form by exposure to antibiotic. METHODS: Three strains of H. pylori, isolated from gastric biopsy specimens of confirmed peptic ulcer, were converted from spiral into coccoid from by exposure to metronidazole. Both spiral and coccoid form of H. pylori were tested for the urease activity, the adherence to Hep-2 cells and the vacuolating cytotoxicity to Hela cells, and the differences of the protein were analysed by SDS-PAGE and Western blot. The mutation of the genes including ureA, ureB,hpaA, vacA and cagA, related with virulence, was detected by means of PCR and PCR-SSCP. RESULTS: In the coccoid H. pylori,the urease activity, the adherence to Hep-2 cells and the vacuolating cytotoxicity to Hela cells all decreased. In strain F44, the rate and index of adherence reduced from 70.0% +/- 5.3% to 33% +/- 5.1% and from 2.6 +/- 0.4 to 0.96 +/- 0.3 (P 【 0.01), respectively. The invasion of coccoid H. pylori into Hep-2 cell could be seen under electronmicroscope. SDS-PAGE showed that the content of the protein with the molecular weight over Mr 74000 decreased, and the hybriditional signal in band M(r) 125000 weakened, while the band M(r)110000 and M(r)63000 strengthened in coccoid H.pylori as shown in Western blot. The results of PCR were all positive, and PCR-SSCP indicated that there may exist the point mutation in gene hpaA or vacA. CONCLUSION: The virulence and the proteins with molecular weight over M(r)74000 in coccoid H.pylori decrease, but no deletion exists in amplification fragments from ureA, ureB, hpaA, vacA and cagA genes, suggesting that coccoid H.pylori may have potential pathogenicity.

Dual-priming oligonucleotide-based multiplex PCR using tissue samples in rapid urease test in the detection of Helicobacter pylori infection

AIM: To investigate whether tissue samples processed by the rapid urease test (RUT) kit are suitable for dual-priming oligonucleotide-based multiplex polymerase chain reaction (DPO-PCR) to detect Helicobacter pylori (H. pylori).

Comparison of three PCR methods for detection of Helicobacter pylori DNA and detection of cagA gene in gastric biopsy specimens

AIM:To comparatively evaluate PCR and other diagnostic methods (the rapid urease test and/or culture) in order to determine which of the three PCR methods (ureA,glmM and 26-kDa,SSA gene) was most appropriate in the diagnosis of Helicobacterpylori(Hpylori) infection and also to evaluate the detection of a putative virulence marker of H pylori,the cage,gene,by PCR in biopsy specimens. METHODS:One hundred and eighty-nine biopsy specimens were collected from 63 patients (three biopsies each) undergoing upper gastroduodenal endoscopy for various dyspeptic symptoms.The PCR methods used to detect H pylori DNA directly from biopsies were the glmM,26-kDa, ureA and then cagA was used to compare the culture technique and CLO for urease with the culture technique being used as the gold standard. RESULTS:Thirty-five percent of the biopsies were positive for H pylori DNA using the 3 PCR methods,while 68% of these were positive for the cagA gene.Twenty-four percent of the biopsies were negative for H pylori DNA in all PCR methods screened.The remaining 41% were either positive for ureA gene only,glmM only,26-kDa only,or ureA+glmM, ureA+26-kDa,glmM+26-kDa.Out of the 35% positive biopsies,41% and 82% were positive by culture and CLO respectively,while all negative biopsies were also negative by culture and cagA.Cag A+ infection was also predominantly found in H pylori DNA of the biopsies irrespective of the clinical diagnosis. CONCLUSION:This method is useful for correctly identifying infections caused by H pylori and can be easily applied in our laboratory for diagnostic purposes.

In vitro effect of amoxicillin and clarithromycin on the 3' region of cagA gene in Helicobacter pylori isolates

AIM:To evaluate the in vitro effect of amoxicillin and clarithromycin on the cag pathogenicity island(cag PAI).METHODS:One hundred and forty-nine clinical isolates of Helicobacter pylori(H.pylori)cultured from gastric biopsies from 206 Colombian patients with dyspeptic symptoms from a high-risk area for gastric cancer were included as study material.Antimicrobial susceptibility was determined by the agar dilution method.Resistant isolates at baseline and in amoxicillin and clarithromycin serial dilutions were subjected to genotyping(cagA,vacA alleles s and m),Glu-Pro-Ile-Tyr-Ala(EPIYA)polymerase chain reaction and random amplified polymorphic DNA(RAPD).Images of the RAPD amplicons were analyzed by Gel-Pro Analyzer 4.5program.Cluster analyses was done using SPSS 15.0statistical package,where each of the fingerprint bands were denoted as variables.Dendrograms were designed by following Ward’s clustering method and the estimation of distances between each pair of H.pylori isolates was calculated with the squared Euclidean distance.RESULTS:Resistance rates were 4%for amoxicillin and 2.7%for clarithromycin with 2%double resistances.Genotyping evidenced a high prevalence of the genotype cagA-positive/vacA s1m1.The 3’region of cagA gene was successfully amplified in 92.3%(12/13)of the baseline resistant isolates and in 60%(36/60)of the resistant isolates growing in antibiotic dilutions.Upon observing the distribution of the number of EPIYA repetitions in each dilution with respect to baseline isolates,it was found that in 61.5%(8/13)of the baseline isolates,a change in the number of EPIYA repetitions lowered antibiotic pressure.The gain and loss of EPIYA motifs resulted in a diversity of H.pylori subclones after bacterial adjustment to changing conditions product of antibiotic pressure.RAPD PCR evidenced the close clonal relationship between baseline isolates and isolates growing in antibiotic dilutions.CONCLUSION:Antibiotic pressure does not induce loss of the cag pathogenicity island,but it can leadin most cases-to genetic rearrangements within the3’region cagA of the founding bacteria that can affect the level of tyrosine phosphorylation impacting on its cellular effects and lead to divergence of cagA-positive subclones.

Prevalence of Helicobacter pylori virulence genotypes among children in Eastern Turkey

AIM:To identify the virulence genotypes of Helicobacter pylori(H.pylori)if present in children in Eastern Turkey and if those genotypes are mostly associated with severe clinical presentations.METHODS:A total of 49 H.pylori positive Turkish children(42 with antral nodularity and 7 with peptic ulcer)who underwent upper gastrointestinal endoscopy with abdominal symptoms during the period from March 2011 to September 2012 were enrolled in this study.Antral nodularity was diagnosed endoscopically by two of the authors.We determined for the presence of cagA,vacA,cagE,iceA and babA2 genotypes of H.pylori isolates in DNA obtained directly from frozen gastric biopsy samples by polymerase chain reaction test using specific primers.RESULTS:Of the 49 H.pylori isolates studied,61.2%,91.8%,22.4%,28.6%,57.1%and 40.8%were positive for the cagA,vacA s1,cagE,iceA1,iceA2 and babA2 genes,respectively.We showed that the most common vacA subtype was s1a(79.6%).However,the s2 gene was found less frequently with an isolation rate of 8.2%of the H.pylori isolates.The genotypes iceA2 and vacA s1m2 were the most frequently found types in children with antral nodularity.In addition,the genotypes iceA1,babA2 and vacA s1m1 were found in similar ratios in all the H.pylori isolates obtained from children with peptic ulcer.The genotypes vacA s2m1and s1c were not observed in any of isolates studied.CONCLUSION:This study showed that vacA s1m2,cagA and iceA2 were the most common genotypes,and no association between antral nodularity and genotypes was observed.

Establishment of a nested-ASP-PCR method to determine the clarithromycin resistance of Helicobacter pylori

AIM: To investigate clarithromycin resistance positions 2142, 2143 and 2144 of the 23 Sr RNA gene in Helicobacter pylori(H. pylori) by nested-allele specific primer-polymerase chain reaction(nested-ASP-PCR).METHODS: The gastric tissue and saliva samples from 99 patients with positive results of the rapid urease test(RUT) were collected. The nested-ASP-PCR method was carried out with the external primers and inner allele-specific primers corresponding to the reference strain and clinical strains. Thirty gastric tissue and saliva samples were tested to determine the sensitivity of nested-ASP-PCR and ASP-PCR methods. Then, clarithromycin resistance was detected for 99 clinical samples by using different methods, including nestedASP-PCR, bacterial culture and disk diffusion. RESULTS: The nested-ASP-PCR method was successfully established to test the resistance mutation points 2142, 2143 and 2144 of the 23 SrR NA gene of H. pylori. Among 30 samples of gastric tissue and saliva, the H. pylori detection rate of nested-ASP-PCR was 90% and 83.33%, while the detection rate of ASP-PCR was just 63% and 56.67%. Especially in the saliva samples, nested-ASP-PCR showed much higher sensitivity in H. pylori detection and resistance mutation rates thanASP-PCR. In the 99 RUT-positive gastric tissue and saliva samples, the H. pylori-positive detection rate by nested-ASP-PCR was 87(87.88%) and 67(67.68%), in which there were 30 wild-type and 57 mutated strains in gastric tissue and 22 wild-type and 45 mutated strains in saliva. Genotype analysis showed that three-points mixed mutations were quite common, but different resistant strains were present in gastric mucosa and saliva. Compared to the high sensitivity shown by nested-ASP-PCR, the positive detection of bacterial culture with gastric tissue samples was 50 cases, in which only 26 drug-resistant strains were found through analyzing minimum inhibitory zone of clarithromycin. CONCLUSION: The nested-ASP-PCR assay showed higher detection sensitivity than ASP-PCR and drug sensitivity testing, which could be performed to evaluate clarithromycin resistance of H. pylori.

DNA diagnostics for reliable and universal identification of Helicobacter pylori

Reliable diagnostics are a major challenge for the detection and treatment of Helicobacter pylori(H.pylori)infection.Currently at the forefront are non-invasive urea breath test(UBT)and stool antigen test(SAT).Polymerase chain reaction(PCR)is not endorsed due to nonspecific primers and the threat of false-positives.The specificity of DNA amplification can be achieved by nested PCR(NPCR),which involves two rounds of PCR.If the primers are properly designed for the variable regions of the 16S rRNA gene,it is not difficult to develop an NPCR assay for the unambiguous identification of H.pylori.Elaborate NPCR for a 454 bp amplicon was validated on 81 clinical biopsy,stool,and saliva samples,each from the same individuals,and compared with available H.pylori assays,namely histology,rapid urease test,SAT,and 13C-UBT.The assay was much more sensitive than simple PCR,and it was equally sensitive in biopsy samples as the 13CUBT test,which is considered the gold standard.In addition,it is sufficiently specific because sequencing of the PCR products exclusively confirmed the presence of H.pylori-specific DNA.However,due to the threshold and lower abundance,the sensitivity was much lower in amplifications from stool or saliva.Reliable detection in saliva also complicates the ability of H.pylori to survive in the oral cavity aside from and independent of the stomach.The reason for the lower sensitivity in stool is DNA degradation;therefore,a new NPCR assay was developed to obtain a shorter 148 bp 16S rRNA amplicon.The assay was validated on stool samples from 208 gastroenterological patients and compared to SAT results.Surprisingly,this NPCR revealed the presence of H.pylori in twice the number of samples as SAT,indicating that many patients are misdiagnosed,not treated by antibiotics,and their problems are interpreted as chronic.Thus,it is unclear how to properly diagnose H.pylori in practice.In the first approach,SAT or UBT is sufficient.If samples are negative,the 148 bp amplicon NPCR assay should be performed.If problems persist,patients should not be considered negative,but due to threshold H.pylori abundance,they should be periodically tested.The advantage of NPCR over UBT is that it can be used universally,including questionable samples taken from patients with achlorhydria,receiving proton pump inhibitors,antibiotics,bismuth compound,intestinal metaplasia,or gastric ulcer bleeding.

Detection of <i>Helicobacter pylori</i>in dental plaque of mexican children by real-time PCR

Dental plaque in adult patients is well identified as a reservoir for Helicobacter pylori. This question still remains unclear in children. The aim of this study is to identify the presence of this bacterium in dental plaque of Mexican pediatric patients, using Real Time Polymerase Chain Reaction (qPCR). Forty patients from 2 to 11 years without dyspeptic symptoms were enrolled. Samples were collected from the subgingival space of the lingual side of the lower molars and cultured in selective medium. Therefore, qPCR analysis was conducted. According to the results obtained in this study, it was found that 35% of the pediatric population who participated tested qPCR positive for the presence of H. pylori in dental plaque samples. No significant associations were detected among isolation rate by gender or age. We found that dental plaque may be a reservoir for H. pylori. However, more research is needed to establish the way of the infection of pediatric population.

Expression of the CagA gene of H.pylori and application of its product

INTRODUCTION Helicobaeter PYlori(HP)Plays an important role inthe uPPer digestive traet diseases.It can be dividedinto two main groups(toxie and non一toxieHP)aeeording to the

Pseudomonas fluorescens-like bacteria from the stomach:A microbiological and molecular study

AIM:To characterize oxidase-and urease-producing bacterial isolates,grown aerobically,that originated from antral biopsies of patients suffering from acid peptic diseases.METHODS:A total of 258 antral biopsy specimens were subjected to isolation of bacteria followed by tests for oxidase and urease production,acid tolerance and aerobic growth.The selected isolates were further characterized by molecular techniques viz.amplifications for 16S rRNA using universal eubacterial and HSP60 gene specific primers.The amplicons were subjected to restriction analysis and partial sequencing.A phylogenetic tree was generated using unweighted pair group method with arithmetic mean(UPGMA) from evolutionary distance computed with bootstrap test of phylogeny.Assessment of acidity tolerance of bacteria isolated from antrum was performed using hydrochloric acid from 10-7 mol/L to 10-1 mol/L.RESULTS:Of the 258 antral biopsy specimens collected from patients,179(69.4%) were positive for urease production by rapid urease test and 31%(80/258) yielded typical Helicobacter pylori(H.pylori) after 5-7 d of incubation under a microaerophilic environment.A total of 240(93%) antral biopsies yielded homogeneous semi-translucent and small colonies after overnight incubation.The partial 16S rRNA sequences revealed that the isolates had 99% similarity with Pseudomonas species.A phylogenetic tree on the basis of 16S rRNA sequences denoted that JQ927226 and JQ927227 were likely to be related to Pseudomonas fluorescens(P.fluorescens).On the basis ofHSP60 sequences applied to the UPGMA phylogenetic tree,it was observed that isolated strains in an aerobic environment were likely to be P.fluorescens,and HSP60 sequences had more discriminatory potential rather than 16S rRNA sequences.Interestingly,this bacterium was acid tolerant for hours at low pH.Further,a total of 250(96.9%) genomic DNA samples of 258 biopsy specimens and DNA from 240 bacterial isolates were positive for the 613 bp amplicons by targeting P.fluorescens-specific conserved putative outer membrane protein gene sequences.CONCLUSION:This study indicates that bacterial isolates from antral biopsies grown aerobically were P.fluorescens,and thus acid-tolerant bacteria other than H.pylori can also colonize the stomach and may be implicated in pathogenesis/protection.

cagA gene distribution in Helicobacter pylon infected native people

To study the virulence of H. Pylon infected native people and the distribution of cagA gene in H. Pylon. Methods: Typing of H. pylori was determined by PCR in 74 clinical isolates by using one primer set for the cagA gene. The rapid-urease test, histological examinations and ELISA were also employed. Results: Prevalence of cagA gene in H. Pylon isolates was 90. 5%,the positive rate of cagA gene in peptic ulcer patients was 94. 9%, higher than that in chronic gastritis patients (85. 7% ), though the difference was insignificant. BOth type Ⅰ (cagA+ )and type Ⅱ (cagA- )isolates led to chronic inflammation of antrum, though the former caused more severe inflammation than the latter. There was no significant difference in seventy of active gastritis, intestinal metaplasia, atrophy and lymph folliciles. Conclusion: High prevalence of cagA gene in H. Pylon isolates from native patients indicates that cagA gene is common in H.pylori strains, and therefore is not reliable as a single marker for the discrimination of H. pylori strains with respect to a specific disease. However, owing to the high sensitivity and specificity, detecting cagA gene of H. Pylon by PCR may be considered as a helpful method in epidemiologic research.