Real‐world <i>Helicobacter pylori</i> diagnosis in patients referred for esophagoduodenoscopy: The gap between guidelines and clinical practice

Shirin, Dor; Matalon, Shay; Avidan, Benjamin; Broide, Efrat; Shirin, Haim

doi:10.1177/2050640615626052

Cited by 12 publications

(9 citation statements)

References 40 publications

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“…Some patients had previous use of PPI and some were frequently self-medicated, so they could not discontinue PPI for an adequate period before endoscopy. Although consistent with previous studies [ 65 , 66 ] and AGA guidelines [ 15 ] we obtained biopsies both from antrum and body for the detection of H. pylori infection, but PPI consumption may reduce the colonization density of H. pylori and leads to false negative results at the histopathology assessment [ 67 ]. Second, the quantitative measurements of opium and alcohol abuse as well as use of NSAIDs and aspirin or other drugs were not addressed in the study.…”

Section: Discussionmentioning

confidence: 71%

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

et al. 2021

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Background Early detection and appropriate treatment of precancerous, mucosal changes could significantly decrease the prevalence of life-threatening gastric cancer. Biopsy of the normal-appearing mucosa to detect Helicobacter pylori and these conditions is not routinely obtained. This study assesses the prevalence and characteristics of H. pylori infection and precancerous conditions in a group of patients suffering from chronic dyspepsia who were subjected to gastric endoscopy and biopsy mapping. Methods This cross-sectional study included dyspeptic patients, not previously treated for H. pylori, undergoing esophagogastroduodenoscopy (EGD) with their gastric endoscopic biopsies obtained for examination for evidence of H. pylori infection and precancerous conditions. Demographic and clinical data on the gender, smoking, opium addiction, alcohol consumption, medication with aspirin, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) and family history of cancer were collected by interviewing the patients and evaluating their health records. The cohort examined consisted of 585 patients with a mean (SD) age of 48.0 (14.46) years, 397 (67.9%) of whom were women. Results H. pylori infection was identified in 469 patients (80.2%) with the highest prevalence (84.2%) in those aged 40–60 years. Opium addiction correlated with a higher a H. pylori infection rate, while alcohol consumption was associated with a lower rate by Odds Ratio 1.98 (95% CI 1.11–3.52) and 0.49 (95% CI 0.26–0.92), respectively. The prevalence of intestinal metaplasia, gastric atrophy and gastric dysplasia was 15.2, 12.6 and 7.9%, respectively. Increased age, positive H. pylori infection, endoscopic abnormal findings and opium addiction showed a statistically significant association with all precancerous conditions, while NSAID consumption was negatively associated with precancerous conditions. For 121 patients (20.7% of all), the EGD examination revealed normal gastric mucosa, however, for more than half (68/121, 56.2%) of these patients, the histological evaluation showed H. pylori infection, and also signs of atrophic mucosa, intestinal metaplasia and dysplasia in 1.7, 4.1 and 1.7%, respectively. Conclusion EGD with gastric biopsy mapping should be performed even in the presence of normal-appearing mucosa, especially in dyspeptic patients older than 40 years with opium addiction in north-eastern Iran. Owing to the high prevalence of precancerous conditions and H. pylori infection among patients with dyspepsia in parts of Iran, large-scale national screening in this country should be beneficial.

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Section: Discussionmentioning

confidence: 71%

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

et al. 2021

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“…10 Based on a study by Shirin et al, the negative test might be induced by using PPI prior to the H. pylori examination, which might cause the misinterpretation as the PPI interferes with the pathogens' viability, morphology, and ability to produce urease. 11 Thus, the diagnosis of H. pylori was considered in this patient, and the initiation of treatment should be justified, especially in patients who exhibit no improvement with prior treatments. The use of PPI was also one of the most frequently identified causes of hypergastrinemia.…”

Section: Discussionmentioning

confidence: 96%

Hypergastrinemia in Children : A Case Report

Wielim

Sumbung

Widodo

2022

Arch Pediatr Gastr Hepatol Nutr

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Gastrin is an important hormone in the gastrointestinal system that promotes gastric acid secretion. Gastrin hormone is produced by the G-cells in the antrum of the stomach. Besides stimulating gastric acid secretion, gastrin also induces the proliferation of the gut epithelial cells, tissue remodelling, and angiogenesis. Gastrin levels higher than 100-150 pg/ml are known as hypergastrinemia. Hypergastrinemia may cause the hypersecretion of stomach acid, which, if not treated properly, may leads to refractory peptic ulcer, severe gastroesophageal reflux disease (GERD), diarrhea, or death due to complications of refractory peptic ulcer. This case presented a 12 years old boy with a chief complaint of severe epigastric pain in the past month, accompanied by nausea, especially during supine position. The patient had a previous history of esophagitis. He showed no significant changes upon empirical PPI treatment. However, slight improvements were observed after the administration of Helicobacter pylori treatment. The gastrin level in this patient was 198 pg/mL. Upon discharge, the patient was still given PPI treatment. During the follow-up visitation, patient complaints had improved significantly, and the patient was planned to undergo routine evaluations of gastrin.

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“…[18], but lower than 61% in the study of Shirin el al. [19] also in patients referred for upper endoscopy. In the latter only 4.5% of patients stopped PPI 2 weeks before the procedure and 10.8% had been on antibiotic treatment within the past four weeks.…”

Section: Discussionmentioning

confidence: 97%

The Validity of the Invasive Tests for Helicobacter Pylori Diagnosis is Unequally Affected by the Consumption of Antibiotics or Pump Inhibitors. Test Performance under Real-World Conditions

Alcedo

Casas

Gotor

et al. 2021

JGLD

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Background and Aims: Patients undergoing upper endoscopy have often used proton pump inhibitors (PPI) and/or antibiotics (ABx) recently. Both drugs have been associated with a poorer yield of the Helicobacter pylori (H. pylori) diagnostic tests. The aim was to assess the accuracy of the polymerase chain reaction test (qPCR), histological exam (HE) and ultra-fast urease test (UFUT) for H. pylori detection in patients that recently used PPI or ABx. Methods: Prospective study recruiting 206 patients who underwent upper endoscopy and gastric biopsies. Demographics and use of PPI/ABx were obtained. Sensibility (Sn), specificity (Sp), predictive value (PV), likelihood ratio (LR) and PABAK concordance index, were calculated, considering as the gold standard the positivity of 2 out of 3 analyzed tests. A global analysis and another one based on the PPI/ABx intake were performed. Results: 48.5% of patients used PPI and 12.8% ABx within the 2 and 4 weeks prior to endoscopy, respectively. The UFUT was positive in 13.1% of patients, HE in 34% and qPCR in 35.9%. UFUT achieved lower Sn (37%) than HE (98%) and qPCR (98%) (p<0.001) overall. ABx were associated with lower Sn in HE (p=0.04) and lower Sp in qPCR (p=0.03). PPI did not associate with a significant drop in Sn and Sp. The concordance between HE and qPCR was 0.83 (95%CI: 0.73-0.89). Conclusions: Under real world conditions, the accuracy and concordance of HE and qPCR to diagnose H. pylori were excellent, but UFUT achieved unsatisfactory outcomes. The intake of ABx was associated with the worse performance, fundamentally for HE. The PPI did not reduce the tests‘ yield significantly.

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Real‐world Helicobacter pylori diagnosis in patients referred for esophagoduodenoscopy: The gap between guidelines and clinical practice

Cited by 12 publications

References 40 publications

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

Hypergastrinemia in Children : A Case Report

The Validity of the Invasive Tests for Helicobacter Pylori Diagnosis is Unequally Affected by the Consumption of Antibiotics or Pump Inhibitors. Test Performance under Real-World Conditions

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