Identificación de las pruebas más sensibles y específicas para el diagnóstico de Helicobacter pylori pre y post-tratamiento en pacientes dispépticos
Identification of the most sensitive and specific tests for the diagnosis of Helicobacter pylori pre and post-treatment dyspeptic patients
DOI:
https://doi.org/10.54495/Rev.Cientifica.v25i2.89Keywords:
fecal antigen, serology, dyspepsia, pepsinogenAbstract
With the objective to determine a non-invasive most sensible and specific test for the diagnosis of H. pylori infection and confirming eradication after treatment, 178 patients with dyspepsia were prospectively studied during treatment at the Endoscopy clinic of the National Cancer Institute (INCAN).
They underwent fecal antigen detection using a commercial immunoassay (Anarapid ®) technique and a panel of serological tests that included IgM, IgA, IgG (CagA) anti-H. pylori by immunosorbent assay (ELISA). These tests were statistically evaluated through 2x2 contingency
tables (Kappa index) comparing with the biopsy results, which is considered the gold standard. Likewise enzyme assays were performed (Pepsinogen I and II) to assess the integrity of the gastric mucosa and determined its correlation with symptoms according to chi-square test.
Findings indicate that the detection of IgA anti-H. pylori had the highest sensitivity (74.2%) and the fecal antigen test had the highest specificity (69.9%) compared to the other tests. Sixty three patients diagnosed with initial stage H. pylori infection received specific treatment and were followed for 5 months to evaluate changes. At the end of five months of specific treatment, the same test panel was gathered.
Results showed that in most patients values pepsinogen I and II were within normal range. In post-treatment evaluation the rate of pepsinogen I / II was normalized in 24.86% of patients and the number of asymptomatic patients increased from 1.1% to 30.99%, which demonstrated the efficacy of treatment.
Results show that fecal antigen and IgA antibody against H. pylori tests are together the recommended tests for diagnosis of pre-treatment infection, whereas in the post-treatment phase, the fecal antigen test demonstrated therapeutic success. Values of pepsinogen I and II were in the normal range for the majority of the study population, which is indicative of suffering from functional dyspepsia or another disease that affects the gastric mucosa. It is further necessary to continue studies of the usefulness of the determination of pepsinogen I / II and its association with the risk of developing gastric cancer.
Downloads
References
Arinton, I. G. (2010). Serum gastrin level and pepsinogen I/II ratio as biomarker of Helicobacter pylori chronic gastritis. Acta Médica Indonesiana, 42, 142–146.
Bermejo, F., Boixeda, D., Gisbert, J. P., Sanz, J. M., Defarges, V., Alvarez, … Martín de Argila, C. (2001). Basal concentrations of gastrin and pepsinogen I and II in gastric ulcer: influence of Helicobacter pylori infection and usefulness in the control of the eradication. Gastroenterologia y Hepatologia, 24, 56–62. https://doi.org/10.1016/S0210-5705(01)78986-8 DOI: https://doi.org/10.1016/S0210-5705(01)78986-8
Biasco, G., Paganelli, G. M., Vaira, D., Holton, J., Di Febo, G., Brillanti, S., … Samloff, I. M. (1993). Serum pepsinogen I and II concentrations and IgG antibody to Helicobacter pylori in dyspeptic patients. Journal of Clinical Pathology, 46, 826–828. https://doi.org/10.1136/jcp.46.9.826 DOI: https://doi.org/10.1136/jcp.46.9.826
Calvet, X., Lario, S., Ramírez-Lázaro, M. J., Montserrat, A., Quesada, M., Reeves, L., … Segura, F. (2010). Comparative accuracy of 3 monoclonal stool tests for diagnosis of Helicobacter pylori infection among patients with dyspepsia. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 50, 323–328. https://doi.org/10.1086/649860 DOI: https://doi.org/10.1086/649860
Correa, P. (2013). Gastric cancer. Overview. Gastroenterology Clinics of North America. 42, 211-217. https://doi.org/10.1016/j.gtc.2013.01.002 DOI: https://doi.org/10.1016/j.gtc.2013.01.002
Figueroa G, G., Troncoso H, M., Toledo B, M. S. & Acuña M, R. (2000). Aplicación de la serología para confirmar la erradicación de Helicobacter pylori en pacientes con úlcera péptica. Revista Médica de Chile, 128(10), 1119–1126. https://doi.org/10.4067/S0034-98872000001000007 DOI: https://doi.org/10.4067/S0034-98872000001000007
Gisbert, J., Cabrera, M. & Pajares, J. (2002). Detección del antígeno de Helicobacter pylori en heces para el diagnóstico inicial de la infección y para la confirmación de su erradicación tras el tratamiento. Medicina Clínica, 118, 401–404. https://doi.org/10.1016/S0025-7753(02)72402-0 DOI: https://doi.org/10.1016/S0025-7753(02)72402-0
Gómez, M. R., Grande, L., Fernández, M. C., Otero, M. . Á., Vargas, J. & Bernal, S. (2000). Utilidad de la detección de antígenos de Helicobacter pylori en heces en el diagnóstico de infección y en el control de la erradicación tras el tratamiento. Medicina Clínica, 114(15), 571–573. https://doi.org/10.1016/S0025-7753(00)71366-2 DOI: https://doi.org/10.1016/S0025-7753(00)71366-2
Hitoshi A., Kagaya, T., Takemori, Y. & Noda, Y. (1997). Changes in serum anti-Helicobacter pylori IgG antibody, pepsinogen I, and pepsinogen II after eradication therapy of Helicobacter pylori. Japanese Journal of Gastroenterology, 94(11), 723–729.
Jurgos, L., Simkovicova, M., Danis, D., Bures, J. & Kopacova, M. (2003). Comparison of serum IgA and IgG antibodies to H. pylori and direct proof of H. pylori. Lekarsky Obzor, 52, 165–166.
Kawai, T., Miki, K., Ichinose, M., Kenji, Y., Miyazaki, I., Kawakami, K., … Mukai, K. (2007). Changes in evaluation of the pepsinogen test result following Helicobacter pylori eradication therapy in Japan. Inflammopharmacology, 15(1), 31–5. https://doi.org/10.1007/s10787-006-0009-y DOI: https://doi.org/10.1007/s10787-006-0009-y
Kreuning, J., Lindeman, J., Biemond, I. & Lamers, C. B. (1994). Relation between IgG and IgA antibody titres against Helicobacter pylori in serum and severity of gastritis in asymptomatic subjects. Journal of Clinical Pathology, 47, 227–231. https://doi.org/10.1136/jcp.47.3.227 DOI: https://doi.org/10.1136/jcp.47.3.227
Li, S., Lu, A. P., Zhang, L. & Li, Y. D. (2003). Anti-Helicobacter pylori immunoglobulin G (IgG) and IgA antibody responses and the value of clinical presentations in diagnosis of H. pylori infection in patients with precancerous lesions. World Journal of Gastroenterology, 9, 755–758. https://doi.org/10.3748/wjg.v9.i4.755 DOI: https://doi.org/10.3748/wjg.v9.i4.755
Macenlle García, R. M., Gayoso Diz, P., Sueiro Benavides, R. A. & Fernández Seara, J. (2006). Prevalencia de la infección por Helicobacter pylori en la población general adulta de la provincia de Ourense. Revista Espanola de Enfermedades Digestivas, 98, 241–248. DOI: https://doi.org/10.4321/S1130-01082006000400003
Miki, K., Ichinose, M., Ishikawa, K. B., Yahagi, N., Matsushima, M., Kakei, N., … Shimizu, Y. (1993). Clinical application of serum pepsinogen I and II levels for mass screening to detect gastric cancer. Japanese Journal of Cancer Research: Gann, 84(10), 1086–90. DOI: https://doi.org/10.1111/j.1349-7006.1993.tb02805.x
Oliveros, R., Albis, R., Ceballos, J., Ospina, J., Villamizar, J., Escobar, J., … Citelly, D. (2003). Evaluación de la concentración sérica de pepsinógeno como método de tamizaje para gastritis atrófica y cáncer gástrico. Revista Colombiana de Gastroenterologia, 18, 73–77.
Pounder, R. E. & Ng, D. (1995). The prevalence of Helicobacter pylori infection in different countries. Alimentary Pharmacology & Therapeutics, 9 Suppl 2, 33–9.
Quintana-Guzmán, E. M., Salas-Chaves, P., Achí-Araya, R., Davidovich-Rose, H. & Schosinsky-Nevermann, K. (2002). Diagnostic value of Helicobacter pylory antibodies in patients referred to the digestive endoscopy service at the Hospital San Vicente de Paul, Costa Rica. Acta Ortopédica Mexicana, 13, 15–23. DOI: https://doi.org/10.32776/revbiomed.v13i1.291
Ramos, A. R. & Sánchez, R. S. (2008). Helicobacter pylori y cáncer gástrico. Revista de Gastroenterología de Perú, 28, 258–266.
Rivas, F. & Hernández, F. (2000). Helicobacter pylori: Factores de virulencia, patología y diagnóstico. Revista Biomedica, 11, 187–205. DOI: https://doi.org/10.32776/revbiomed.v11i3.236
She, R. C., Wilson, A. R. & Litwin, C. M. (2009). Evaluation of Helicobacter pylori immunoglobulin G (IgG), IgA, and IgM serologic testing compared to stool antigen testing. Clinical and Vaccine Immunology, 16, 1253–1255. DOI: https://doi.org/10.1128/CVI.00149-09
She, R. C., Wilson, A. R., Litwin, C. M., Quintana-Guzmán, E. M., Salas-Chaves, P., Achí-Araya, R., … Kopacova, M. (2002). Comparison of serum IgA and IgG antibodies to H. pylori and direct proof of H. pylori. Acta Ortopédica Mexicana, 13(8), 1253–5. DOI: https://doi.org/10.32776/revbiomed.v13i1.291
Sierra, F., Gutiérrez, O., Gómez, M. C., Camargo, H., Serrano, B. & Otero, W. (1990). Campylobacter pylori en úlcera duodenal , gastritis crónica y dispepsia no ulcerosa. Acta Médica Colombiana, 15, 74–83.
Torres, L. & Rodríguez, B. (2008). Principales factores de patogenia en la infección por Helicobacter pylori. Revista del Centro Nacional de Investigacions Cientificas, Ciencias Biológicas, 39, 52–62.
World Gastroenterology Organization. (2010). Helicobacter en los países en desarrollo. Recuperado el 10 de febrero de 2015 de http://www.worldgastroenterology.org/assets/downloads/es/pdf/guidelines/helicobacter_pylori_en_los_paises_desarrollo.pdf
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2015 V. Matta de García, K.J. Lange, N.I. Hornquist, M.J. Camó, M.A. Benito, E.A. Maldonado, J.H. Gómez, A. Zetina, F. Nave, K.M. Guerrero
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License 4.0 that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
