Noninvasive stool antigen assay can effectively screen Helicobacter pylori Infection and assess success of eradication therapy in hemodialysis patients.
Helicobacter pylori (H pylori) stool antigen (HpSA), serological antibody against H pylori (immunoglobulin G [IgG]), and urea breath test (UBT) are noninvasive methods used to detect H pylori infection that can allow a patient to avoid the discomfort and risk of invasive endoscopy. However, because the UBT has proven not highly reliable in patients with end-stage renal disease (ESRD), this study attempts to investigate the diagnostic efficacy of HpSA and IgG for H pylori detection in 80 patients with ESRD and 80 dyspeptic patients without renal function impairment as a control group. All patients in both study groups underwent panendoscopy to obtain gastric biopsy specimens for histological examination and H pylori culture. With H pylori infection defined as a positive result on either histological examination or culture, we evaluated the reliability of HpSA and serum IgG in detecting H pylori infection. Forty of the patients with ESRD (50%) and 48 patients in the control group (60%) were proven to be infected with H pylori. To eradicate H pylori infection, these patients were administered a 1-week course of triple therapy. To evaluate the success of H pylori eradication, 38 patients in the ESRD group and 44 patients in the control group underwent a follow-up endoscopy and provided stool samples for HpSA 6 to 8 weeks later. Success of H pylori eradication was found in 86.8% of the patients with ESRD (33 of 38 patents) and 84.1% of the control patients (37 of 44 patients). Before therapy, HpSA for H pylori detection was 97.5% sensitive and 97.5% specific in patients with ESRD, as effective as that in the control group. After therapy, HpSA was 100% sensitive and more than 96% specific to detect the failure of H pylori eradication therapy in both the ESRD and control groups. Conversely, the use of IgG as a screening method for H pylori infection proved to be less effective because it showed a sensitivity of 87.5% and specificity of 80% in this study. Monitoring the success of triple therapy, IgG had a specificity of only 21.9% in the ESRD group and 24.3% in the control group. In summary, HpSA is a noninvasive and reliable tool to screen H pylori infection before therapy and assess the success of eradication therapy in patients with ESRD.
Wang
Y L
YL
Chung Hwa College of Medical Technology, Department of Internal Medicine, Chu-Pei, Taiwan.
Sheu
B S
BS
Huang
J J
JJ
Yang
H B
HB
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood / Q000187:drug effects; D000942:Antigens, Bacterial / Q000032:analysis*; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use; D003248:Constipation / Q000139:chemically induced; D003967:Diarrhea / Q000139:chemically induced; D004359:Drug Therapy, Combination; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000187:drug effects; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use; D006435:Renal Dialysis; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D007074:Immunoglobulin G; D010406:Penicillins; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole