Screening dyspepsia by serology to Helicobacter pylori

Sobala, G. M.; Crabtree, Jean E.; Pentith, J. A.; Rathbone, B. J.; Shallcross, T M; Wyatt, J I; Dixon, M. F.; Heatley, R. V.; Axon, Anthony

doi:10.1016/0140-6736(91)90085-4

Cited by 203 publications

(100 citation statements)

References 15 publications

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“…It was proposed as pre-endoscopy screening to reduce endoscopy examination in young dyspeptic patients and in epidemiologic studies. 7,27,28 A significant difference in H. pylori seroprevalence was observed between aboriginal townships and metropolitan precincts in this study. A poor water supply system, sewage disposal, and other environmental hygiene in aboriginal townships might play contributing roles in the acquisition of H. pylori infection in central Taiwan.…”

Section: Discussionmentioning

confidence: 69%

Seroepidemiology of Helicobacter pylori infection among preschool children in Taiwan.

Lin¹,

Nieh²,

Wang³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Helicobacter pylori is associated with chronic antral gastritis that is related to duodenal ulcer, gastric ulcer, and probably gastric adenocarcinoma. Infection with H. pylori during childhood is considered an important risk factor for gastric carcinoma in adult life. To examine the epidemiologic characteristics of H. pylori infection among preschool children in central Taiwan, a community-based survey was carried out in 54 kindergartens in 10 urban townships, 10 metropolitan precincts, and 2 aboriginal townships randomly selected through stratified sampling. Serum specimens of 2,551 healthy preschool children (3-6 years old) randomly sampled from study kindergartens were screened for antibodies to H. pylori by latex agglutination and ELISA methods. Multivariate-adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) were estimated by multiple logistic regression analysis. A total of 207 subjects were antibody-positive, giving a prevalence of 8.1%. The overall seropositive rates were 4.5% in 3-year-old group, 4.4% in 4-year-old group, 9.4% in 5-year-old group, and 11.7% in 6-year-old group. The older the age, the higher the seroprevalence (OR ϭ 3.2, 95% CI ϭ 1.5-6.8 for 3-year-old children versus the 6-year-old children). Seroprevalence was not different between boys and girls. The aboriginal townships had a seroprevalence greater than the urban townships and metropolitan precincts (OR ϭ 2.6, 95% CI ϭ 1.9-3.7). The larger the number of siblings, the higher the seroprevalence (OR ϭ 2.4, 95% CI ϭ 1.0-5.8 for those with no sibling versus those with Ն 3 siblings). In the multiple logistic regression analysis, the seroprevalence of H. pylori remained significantly increased with age, aboriginal township, and large sibship size after multivariate adjustment. A poor water supply system, sewage disposal, and other environmental hygiene in the aboriginal townships might have played some role in infection with H. pylori. The early childhood transmission among siblings might also be an important determinant of H. pylori seropositivity in Taiwan.Infection with Helicobacter pylori has been causally related to chronic gastritis and peptic ulcer, and indirectly related to gastric adenocarcinoma and primary gastric B cell lymphoma.

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Section: Discussionmentioning

confidence: 69%

Seroepidemiology of Helicobacter pylori infection among preschool children in Taiwan.

Lin¹,

Nieh²,

Wang³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…In this study, we applied a novel approach to observe the effect of increasing age and presence of atrophic gastritis on the diagnostic performance of H. pylori IgG and IgA tests. The IgG test was highly sensitive in adult patients, which makes it an excellent choice for the test-and-treat approach recommended for young adult dyspeptic patients (15,21). Both tests demonstrated high specificity in subjects below f Low PGI levels (Ͻ28 g/liter) by Gastroset PGI EIA.…”

mentioning

confidence: 96%

Age-Dependent Accuracy of Helicobacter pylori Antibody Assays for Adults, with Special Emphasis on Atrophic Gastritis

Salomaa-Räsänen

Kosunen

Mattila

et al. 2004

Clin Vaccine Immunol

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The accuracy of Helicobacter pylori antibody assays for 561 consecutive adult outpatients who had undergone gastroscopy was studied. The sensitivity of an immunoglobulin G test was 99 to 100% for all age groups, but the specificity declined by age group, from 99% for those aged 15 to 49 years to 75% for those aged >65 years. The exclusion of false-positive results for patients with atrophic gastritis improved the specificity to 93 to 97% for the older age groups.Helicobacter pylori infection is associated with gastritis, peptic ulcer disease, and gastric malignancies (1). In about onethird or up to one-half of those infected with H. pylori, gastritis proceeds to atrophic gastritis, resulting in a loss of mucosal glands, decreased helicobacter colonization and, when affecting the corpus mucosa, decreased secretion of pepsinogen I (PGI) (10, 23).Most helicobacter-infected subjects have specific circulating immunoglobulin G (IgG) antibodies. However, IgA antibodies are found in approximately two-thirds of infected subjects (9). Of infected individuals, 2 to 7% show an elevated level of IgA antibody only (5, 9). Patients with atrophic corpus gastritis often have positive helicobacter serology, although microscopic examination (6, 22), culture of biopsy samples, and even the urea breath test remain helicobacter negative (8). These particular patients may still be infected, as shown by rapidly falling antibody titers after therapy (7).Enzyme immunoassay (EIA) is the most commonly used serological method for detecting antibodies to H. pylori. The best commercial kits have shown sensitivities and specificities of 90% to in excess of 95% (3, 12 Biopsy samples. Gastroscopies were performed by one of the authors (A.S.-R.) in a routine manner, with two biopsies from the gastric antrum (2 cm or more from the pylorus), two biopsies from the large curve of the gastric corpus for histological examination, and additional biopsies (one from the antrum and one from the corpus) for culture.Formalin-fixed biopsy specimens were embedded in paraffin. Tissue sections of 3 m were cut at three levels per biopsy and placed on one slide. The tissue sections were stained with hematoxylin and eosin, Alcian blue (pH 2.5)-periodic acidSchiff, and modified Giemsa. Gastritis was classified according to the Sydney System, in a blinded fashion, by one pathologist (J.M.) (20).The biopsies were mailed for culture in Transpocult tubes (Orion Diagnostica, Espoo, Finland). The specimens were cultured for H. pylori for up to 12 days on Brucella agar plates (Becton Dickinson, Sparks, Md.) (18) supplemented with whole horse blood (7%) and on selective Brucella agar plates containing Iso-Vitalex (1%), vancomycin (6 mg/liter), amphotericin B (2 mg/liter), and nalidixic acid (20 mg/liter).Results were considered helicobacter positive if culture or histology or both were positive.Serum tests. Serum samples were taken during each patient's visit to the endoscopic unit and were stored at Ϫ20°C until analyzed. Sera were tested for H. pylori IgG and IgA antibodie...

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“…This could reduce endoscopies in young dyspeptic patients by 23-66%, while detecting almost 100% of peptic ulcers in those not taking NSAIDs. [17][18][19] It is possible that this strategy may not reassure patients adequately and may simply transfer the cost of managing dyspepsia from hospital to primary care. A decision-analytic model comparing empirical anti-secretory therapy with H. pylori screening found that it would take 5-18 years for savings to accrue if the latter strategy did not influence patient behaviour.…”

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confidence: 99%

The management of dyspepsia: a systematic review.

Delaney

Moayyedi²,

Deeks³

et al. 2000

Health Technology Assessment

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Screening dyspepsia by serology to Helicobacter pylori

Cited by 203 publications

References 15 publications

Seroepidemiology of Helicobacter pylori infection among preschool children in Taiwan.

Seroepidemiology of Helicobacter pylori infection among preschool children in Taiwan.

Age-Dependent Accuracy of Helicobacter pylori Antibody Assays for Adults, with Special Emphasis on Atrophic Gastritis

The management of dyspepsia: a systematic review.

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