A serologic survey of Helicobacter pylori infection in 3281 Italian patients endoscoped for upper gastrointestinal symptoms

Abstract

Aim:To assess the seroprevalence of Helicobacter pylori infection in a large series of patients with upper gastrointestinal symptoms referred for their first upper gastrointestinal endoscopy, and to evaluate any association with disease. Methods: A large survey of 3281 dyspeptic patients undergoing their first endoscopic examination was undertaken, involving 93 centres in Italy. A blood sample was taken from each participant, for measuring IgG antibodies against H. pylori using a commercially available kit, and two biopsies of the antral gastric mucosa were obtained for evaluating a Giemsa‐stained specimen. Results: Endoscopic macroscopic diagnoses included normal mucosa (25.3%), gastroduodenitis (51.6%), gastric and duodenal ulcers (3.7 and 14.9%, respectively) and other conditions, including gastric cancer (0.8%). Overall, the seroprevalence result was 71.3% with a strong positive association with increasing age and male sex and a negative one with educational level. According to endoscopic diagnoses, the association with H. pylori seropositivity was highest for duodenal and gastric ulcer (multivariate odds ratio: 6.1 and 2.2) and lowest for carcinoma. The comparison between the results of serology and the single Giemsa‐stained specimen showed good reliability of H. pylori IgG, particularly in a subgroup (n = 2056) for which the interpretation was performed by a single dedicated pathologist: sensitivity and specificity were 92 and 78%, respectively. Conclusion: Commercial IgG serology is a reliable tool for the assessment of H. pylori infection in large‐scale multicentre surveys. A very high seroprevalence among dyspeptic patients was confirmed, particularly in the presence of peptic disease. Factors associated with the infection were very similar to those usually reported in the general population, but male patients showed a significantly higher prevalence.

Blood tests in the management of Helicobacter pylori infection

“…63 The results of a large multicentre study carried out in Italy involving over 3000 patients examined by endoscopy in more than 90 endoscopy units have recently been published. 64 CagA prevalence was assessed by ELISA in this large population, and the preliminary results in over 1300 patients confirm the association between CagA and major gastroduodenal pathology (table 6).…”

Does hospital work constitute a risk factor for Helicobacter pylori infection?

“…Education level was used as a surrogate measure of socio-economic status as reported previously. 28,29 An inverse relationship between educational attainment and infection in the overall population was seen in univariate analysis, showing more risk for healthcare personnel with %8 years of education compared with staff with a university education (Table II). As reported in Table I, in the subgroup of general medical staff, personnel with a university education showed a significantly lower prevalence of infection (P!0.01) compared with personnel with a lower education level.…”

Familial clustering of Helicobacter pylori infection: population based study Commentary: Helicobacter pylori---the story so far

“…A cut off antibody titre of 10 μg/ml was used to classify subjects as positive or negative, as recommended by the manufacturer (sensitivity 96%, specificity 93%) 28. The same IgG antibody assay has been recently used in another multicentre Italian study and showed a sensitivity of 98% and specificity of 78% when compared with a single Giemsa stained histology specimen 29. To test assay reliability we analysed about 1 in 40 samples twice, with the laboratory blinded to the previous result.…”