title: A Rapid and Accurate Method to Evaluate Helicobacter pylori Infection, Clarithromycin Resistance, and CYP2C19 Genotypes Simultaneously From Gastric Juice.
abstract: Because Helicobacter pylori (H pylori) would cause carcinogenesis of the stomach, we need sufficient information for deciding on an appropriate strategy of eradication. Many factors affect the efficacy of eradication including antimicrobial resistance (especially clarithromycin resistance) and CYP2C19 polymorphism. This study was to survey the efficiency of gastric juice for detecting H pylori infection, clarithromycin resistance, and CYP2C19 polymorphism.The specimens of gastric juice were collected from all patients while receiving gastroscopy. DNA was extracted from gastric juice and then urease A and cag A were amplified by polymerase chain reaction (PCR) for detecting the existence of H pylori. By PCR-restriction fragment length polymorphism (PCR-RFLP), the 23S rRNA of H pylori and CYP2C19 genotypes of host were examined respectively. During endoscopy examination, biopsy-based specimens were also collected for rapid urease test, culture, and histology. The blood samples were also collected for analysis of CYP2C19 genotypes. We compared the results of gastric juice tests with the results of traditional clinical tests.When compared with the results from traditional clinical tests, our results from gastric juice showed that the sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and accuracy to detect H pylori infection were 92.1% (105/114), 92.9% (143/154), 90.5% (105/116), 94.1% (143/152), and 92.5% (248/268), respectively. The SEN, SPE, PPV, and NPV to detect clarithromycin resistance were 97.3% (36/37), 91.5% (43/47), 90.0% (36/40), and 97.7% (43/44), respectively. By using PCR-RFLP, the consistency of human CYP2C19 gene polymorphism from blood samples and gastric juice was as high as 94.9% (149/157).The manipulated gastric juice is actually an effective diagnostic sample for evaluation of H pylori existence, clarithromycin resistance, and host CYP2C19 polymorphism.
authors.affiliation: From the Division of Gastroenterology, Department of Internal Medicine (C-HK, C-JL, H-MH, H-YS, M-CW, D-CW), Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine (C-HK, H-MH, Y-HC, D-CW), Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Stem Cell Research (C-HK, H-MW, D-CW), Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Microbiology and Immunology (C-CY, L-LC), Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine (F-CK), E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine (H-YS, M-CW, D-CW), Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine (Y-HC), Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Fragrance and Cosmetic Science (H-MW), Kaohsiung Medical University, Kaohsiung, Taiwan; and Department of Gastroenterology (J-LR), Zhongshan Hospital affiliated to Xiamen University, Xiamen, Fujian, China; Center for Infectious Disease and Cancer Research (D-CW), Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Kuo
authors.forename: Chung-Jung
authors.initials: CJ
authors.lastname: Liu
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Yang
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Kuo
authors.forename: Huang-Ming
authors.initials: HM
authors.lastname: Hu
authors.forename: Hsiang-Yao
authors.initials: HY
authors.lastname: Shih
authors.forename: Meng-Chieh
authors.initials: MC
authors.lastname: Wu
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.forename: Hui-Min David
authors.initials: HD
authors.lastname: Wang
authors.forename: Jian-Lin
authors.initials: JL
authors.lastname: Ren
authors.forename: Deng-Chyang
authors.initials: DC
authors.lastname: Wu
authors.forename: Lin-Li
authors.initials: LL
authors.lastname: Chang
mesh_terms: D000942:Antigens, Bacterial / Q000235:genetics; D001426:Bacterial Proteins / Q000235:genetics; D017291:Clarithromycin / Q000494:pharmacology*; D065731:Cytochrome P-450 CYP2C19 / Q000032:analysis / Q000235:genetics*; D005750:Gastric Juice; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000235:genetics*; D016480:Helicobacter pylori / Q000235:genetics*; D006801:Humans; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D012680:Sensitivity and Specificity; D014510:Urease / Q000235:genetics
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori; D065731:Cytochrome P-450 CYP2C19; D014510:Urease; D017291:Clarithromycin