Early pregnancy is commonly characterized by the disturbance of digestive function, characteristically manifested by nausea and vomiting. These symptoms during early pregnancy usually disappear spontaneously after abo...Early pregnancy is commonly characterized by the disturbance of digestive function, characteristically manifested by nausea and vomiting. These symptoms during early pregnancy usually disappear spontaneously after about 12 weeks. In a minority of pregnant women, these symptoms are very severe, and are associated with weight loss, dehydration, acidosis from starvation,展开更多
AIM: To estimate the test characteristics of Heli- cobacter pylori (Hpylori) serology and of C14-urea breath test (C14-UBT) in two different peptic ulcer populations and in community controls. Second, the aim was to e...AIM: To estimate the test characteristics of Heli- cobacter pylori (Hpylori) serology and of C14-urea breath test (C14-UBT) in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of H pylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations. METHODS: Vagotomized (n= 83), medically treated peptic ulcer patients (n=73) and one reference group of community controls (n=88) were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated. RESULTS: The prevalence of H pylori infection varied from 70% to 79%. The C14-UBT had high accuracycompared to the serology test. The sensitivity of the serology test was good, but the specificity was low (41%-71%). The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak. CONCLUSION: The accuracy of C14-UBT to diagnose H pylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.展开更多
Helicobacter pylori(H.Pylori)is a gram-negative,flagellated and spiral-shaped bacterial pathogen that impacts approximately 46%among pregnant women globally and has been associated with various maternal-fetal complica...Helicobacter pylori(H.Pylori)is a gram-negative,flagellated and spiral-shaped bacterial pathogen that impacts approximately 46%among pregnant women globally and has been associated with various maternal-fetal complications.Iron deficiency anemia,fetal growth restriction,cardiovascular diseases,and insufficient nutrient absorption can be observed in pregnant women,as well as miscarriages and pregnancy-specific hypertensive disease,such as pre-eclampsia.Thus,the evidence supports the influence of H.pylori infection on fetal implantation/placentation failure,and positive strains of the cytotoxin-associated gene A of H.Pylori were reported as the most prevalent in these conditions.However,current knowledge indicates a relationship between this infection and the occurrence of hyperemesis gravidarum,characterized by frequent nausea and vomiting.Regarding the diagnosis of this bacterial infection,non-invasive approaches such as stool antigen test,urea breath test,and serological tests are more accepted during pregnancy,as they are easy to carry out and cost-effective.Finally,the bacteria eradication therapy should consider the risks and benefits for the pregnant woman and her child,with pharmacological intervention depending on the clinical presentation.展开更多
Helicobacter pylori(H.pylori)infection is investigated in gastric diseases even during pregnancy.In particular,this Gram-negative bacterium seems to be associated with hyperemesis gravidarum,a severe form of nausea an...Helicobacter pylori(H.pylori)infection is investigated in gastric diseases even during pregnancy.In particular,this Gram-negative bacterium seems to be associated with hyperemesis gravidarum,a severe form of nausea and vomiting during pregnancy.During the last decade,the relationship among H.pylori and several extra-gastric diseases strongly emerged in literature.The correlation among H.pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia,thrombocytopenia,fetal malformations,miscarriage,pre-eclampsia and fetal growth restriction.H.pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms:depletion of micronutrients(iron and vitamin B12)in maternal anemia and fetal neural tube defects;local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia;cross-reaction between specific anti-H.pylori antibodies and antigens localized in placental tissue and endothelial cells(preeclampsia,fetal growth restriction,miscarriage).Since H.pylori infection is most likely acquired before pregnancy,it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H.pylori with a negative impact not only on maternal health(nutritional deficiency,organ injury,death),but also on the fetus(insufficient growth,malformation,death)and sometime consequences can be observed later in life.Another important issue addressed by investigators was to determine whether it is possible to transmit H.pylori infection from mother to child and whether maternal anti-H.pylori antibodies could prevent infant’s infection.Studies on novel diagnostic and therapeutic methods for H.pylori are no less important,since these are particularly sensitive topics in pregnancy conditions.It could be interesting to study the possible correlation between H.pylori infection and other pregnancy-related diseases of unknown etiology,such as gestational diabetes mellitus,obstetric cholestasis and spontaneous preterm delivery.Since H.pylori infection is treatable,the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.展开更多
Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication t...Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication therapy.Only highly accurate tests should be used in clinical practice,and the sensitivity and specificity of an adequate test should exceed 90%.The choice of tests should take into account clinical circumstances,the likelihood ratio of positive and negative tests,the cost-effectiveness of the testing strategy and the availability of the tests.This review concerns some of the most recent developments in diagnostic methods of H.pylori infection,namely the contribution of novel endoscopic evaluation methodologies for the diagnosis of H.pylori infection,such as magnifying endoscopy techniques and chromoendoscopy.In addition,the diagnostic contribution of histology and the urea breath test was explored recently in specific clinical settings and patient groups.Recent studies recommend enhancing the number of biopsy fragments for the rapid urease test.Bacterial culture from the gastric biopsy is the gold standard technique,and is recommended for antibiotic susceptibility test.Serology is used for initial screening and the stool antigen test is particularly used when the urea breath test is not available,while molecular methods have gained attention mostly for detecting antibiotic resistance.展开更多
AIM: To study the diagnosis of He/icobacterpy/ori(H pylori) infection through the determination of serum levels of anti-H pylori IgG and IgA antibodies, and the levels of anti- H pylori IgA antibodies in duodenal flui...AIM: To study the diagnosis of He/icobacterpy/ori(H pylori) infection through the determination of serum levels of anti-H pylori IgG and IgA antibodies, and the levels of anti- H pylori IgA antibodies in duodenal fluid. METHODS: Data were collected from 93 patients submitted to upper digestive endoscopy due to dyspeptic symptoms. The patients were either negative (group A) or positive (group B) to Hpyloriby means of both histological detection and urease tests. Before endoscopy, peripheral blood was collected for the investigation of anti-H pylori IgG and IgA antibodies. To perform the urease test, biopsies were obtained from the gastric antrum. For the histological evaluation, biopsies were collected from the gastric antrum (greater and lesser curvatures) and the gastric body. Following this, duodenal fluid was collected from the first and second portions of the duodenum. For the serological assaying of anti-Hpy/oriIgG and IgA, and anti-Hpy/oriIgA in duodenal fluids, the ELISA method was utilized. RESULTS: The concentration of serum IgG showed sensitivity of 64.0%, specificity of 83.7%, positive predictive value of 82.0%, negative predictive value of 66.6% and accuracy of 73.1% for the diagnosis of H pyloriinfection. For the same purpose, serum IgA showed sensitivity of 72.0%, specificity of 65.9%, positive predictive value of 72.0%, negative predictive value of 67.4% and accuracy of 69.8%. If the serological tests were considered together, i.e. when both were positive or negative, the accuracy was 80.0%, sensitivity was 86.6%, specificity was 74.2%, positive predictive value was 74.2% and negative predictive value was 86.6%. When values obtained in the test for detecting IgA in the duodenal fluid were analyzed, no significant difference (P=0.43) was observed between the values obtained from patients with or without Hpyloriinfection. CONCLUSION: The results of serum IgG and IgA tests for H pylori detection when used simultaneously, are more efficient in accuracy, sensitivity and negative predictive value, than those when used alone. The concentration of IgA antibodies in duodenal fluid is not useful in identifying patients with or without H pylori.展开更多
文摘Early pregnancy is commonly characterized by the disturbance of digestive function, characteristically manifested by nausea and vomiting. These symptoms during early pregnancy usually disappear spontaneously after about 12 weeks. In a minority of pregnant women, these symptoms are very severe, and are associated with weight loss, dehydration, acidosis from starvation,
文摘AIM: To estimate the test characteristics of Heli- cobacter pylori (Hpylori) serology and of C14-urea breath test (C14-UBT) in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of H pylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations. METHODS: Vagotomized (n= 83), medically treated peptic ulcer patients (n=73) and one reference group of community controls (n=88) were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated. RESULTS: The prevalence of H pylori infection varied from 70% to 79%. The C14-UBT had high accuracycompared to the serology test. The sensitivity of the serology test was good, but the specificity was low (41%-71%). The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak. CONCLUSION: The accuracy of C14-UBT to diagnose H pylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.
文摘Helicobacter pylori(H.Pylori)is a gram-negative,flagellated and spiral-shaped bacterial pathogen that impacts approximately 46%among pregnant women globally and has been associated with various maternal-fetal complications.Iron deficiency anemia,fetal growth restriction,cardiovascular diseases,and insufficient nutrient absorption can be observed in pregnant women,as well as miscarriages and pregnancy-specific hypertensive disease,such as pre-eclampsia.Thus,the evidence supports the influence of H.pylori infection on fetal implantation/placentation failure,and positive strains of the cytotoxin-associated gene A of H.Pylori were reported as the most prevalent in these conditions.However,current knowledge indicates a relationship between this infection and the occurrence of hyperemesis gravidarum,characterized by frequent nausea and vomiting.Regarding the diagnosis of this bacterial infection,non-invasive approaches such as stool antigen test,urea breath test,and serological tests are more accepted during pregnancy,as they are easy to carry out and cost-effective.Finally,the bacteria eradication therapy should consider the risks and benefits for the pregnant woman and her child,with pharmacological intervention depending on the clinical presentation.
文摘Helicobacter pylori(H.pylori)infection is investigated in gastric diseases even during pregnancy.In particular,this Gram-negative bacterium seems to be associated with hyperemesis gravidarum,a severe form of nausea and vomiting during pregnancy.During the last decade,the relationship among H.pylori and several extra-gastric diseases strongly emerged in literature.The correlation among H.pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia,thrombocytopenia,fetal malformations,miscarriage,pre-eclampsia and fetal growth restriction.H.pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms:depletion of micronutrients(iron and vitamin B12)in maternal anemia and fetal neural tube defects;local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia;cross-reaction between specific anti-H.pylori antibodies and antigens localized in placental tissue and endothelial cells(preeclampsia,fetal growth restriction,miscarriage).Since H.pylori infection is most likely acquired before pregnancy,it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H.pylori with a negative impact not only on maternal health(nutritional deficiency,organ injury,death),but also on the fetus(insufficient growth,malformation,death)and sometime consequences can be observed later in life.Another important issue addressed by investigators was to determine whether it is possible to transmit H.pylori infection from mother to child and whether maternal anti-H.pylori antibodies could prevent infant’s infection.Studies on novel diagnostic and therapeutic methods for H.pylori are no less important,since these are particularly sensitive topics in pregnancy conditions.It could be interesting to study the possible correlation between H.pylori infection and other pregnancy-related diseases of unknown etiology,such as gestational diabetes mellitus,obstetric cholestasis and spontaneous preterm delivery.Since H.pylori infection is treatable,the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.
文摘Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication therapy.Only highly accurate tests should be used in clinical practice,and the sensitivity and specificity of an adequate test should exceed 90%.The choice of tests should take into account clinical circumstances,the likelihood ratio of positive and negative tests,the cost-effectiveness of the testing strategy and the availability of the tests.This review concerns some of the most recent developments in diagnostic methods of H.pylori infection,namely the contribution of novel endoscopic evaluation methodologies for the diagnosis of H.pylori infection,such as magnifying endoscopy techniques and chromoendoscopy.In addition,the diagnostic contribution of histology and the urea breath test was explored recently in specific clinical settings and patient groups.Recent studies recommend enhancing the number of biopsy fragments for the rapid urease test.Bacterial culture from the gastric biopsy is the gold standard technique,and is recommended for antibiotic susceptibility test.Serology is used for initial screening and the stool antigen test is particularly used when the urea breath test is not available,while molecular methods have gained attention mostly for detecting antibiotic resistance.
文摘AIM: To study the diagnosis of He/icobacterpy/ori(H pylori) infection through the determination of serum levels of anti-H pylori IgG and IgA antibodies, and the levels of anti- H pylori IgA antibodies in duodenal fluid. METHODS: Data were collected from 93 patients submitted to upper digestive endoscopy due to dyspeptic symptoms. The patients were either negative (group A) or positive (group B) to Hpyloriby means of both histological detection and urease tests. Before endoscopy, peripheral blood was collected for the investigation of anti-H pylori IgG and IgA antibodies. To perform the urease test, biopsies were obtained from the gastric antrum. For the histological evaluation, biopsies were collected from the gastric antrum (greater and lesser curvatures) and the gastric body. Following this, duodenal fluid was collected from the first and second portions of the duodenum. For the serological assaying of anti-Hpy/oriIgG and IgA, and anti-Hpy/oriIgA in duodenal fluids, the ELISA method was utilized. RESULTS: The concentration of serum IgG showed sensitivity of 64.0%, specificity of 83.7%, positive predictive value of 82.0%, negative predictive value of 66.6% and accuracy of 73.1% for the diagnosis of H pyloriinfection. For the same purpose, serum IgA showed sensitivity of 72.0%, specificity of 65.9%, positive predictive value of 72.0%, negative predictive value of 67.4% and accuracy of 69.8%. If the serological tests were considered together, i.e. when both were positive or negative, the accuracy was 80.0%, sensitivity was 86.6%, specificity was 74.2%, positive predictive value was 74.2% and negative predictive value was 86.6%. When values obtained in the test for detecting IgA in the duodenal fluid were analyzed, no significant difference (P=0.43) was observed between the values obtained from patients with or without Hpyloriinfection. CONCLUSION: The results of serum IgG and IgA tests for H pylori detection when used simultaneously, are more efficient in accuracy, sensitivity and negative predictive value, than those when used alone. The concentration of IgA antibodies in duodenal fluid is not useful in identifying patients with or without H pylori.