Recent News about Helicobacter pylori

(Full details of the references below can be provided upon request.)

What is the preferred diagnostic method for H. pylori infections?

•  The 13 C Urea Breath Test (UBT) is considered the non-invasive test of choice, indeed the gold standard, for diagnosing active H. pylori infection and for confirming eradication after treatment. Malfertheiner P. et. al. , Digestion 2005, 71, 206 – 207. Smellie W.S.A. et. al ., J of Clinical Pathology 2005, 58, 1016 – 1024.

•  Serology tests are not recommended in developed countries with infection rates < 60% due to their lower sensitivity and specificity. Saliva and urine tests also have low sensitivity and specificity, and stool tests had lower sensitivity and specificity in post-therapy testing. Vaira D. et. al. , Gut 2001, 48, 287 – 289 (March).

When should the 13 C Urea Breath Test (UBT) be performed?

•  For patients with gastric or duodenal ulcers who were not previously tested, and patients using NSAIDs with diagnosed or previous gastric ulcer according to United Kingdom “Best practice”. Also patients with uncomplicated and uninvestigated dyspepsia not improved by acid reduction methods. This is the “test and treat” approach consisting of a noninvasive test and triple therapy if infected. Smellie W.S.A. et. al ., J of Clinical Pathology 2005, 58, 1016 – 1024.

•  The “test and treat” approach to patients with uncomplicated dyspepsia and less than 50 years old is also recommended in Canada and Europe . Hunt R.H. et. al. Can J Gastroenterol 1999, 13, 213 – 7. Malfertheiner P. et. al. , Aliment Pharmacol Ther 2002, 16, 167 – 80.

•  Eradication of the H. pylori infection in Chinese carriers prevented stomach cancer in cases with no stomach lesions, but had little benefit if pre-cancerous lesions were already present, thus showing the benefit of early eradication. Wong, C.Y. et. al. , J American Medical Assoc. , January 14, 2004 – Vol 291, 187-194.

•  Test and treat for dyspepsia was found to be as efficient as prompt endoscopy. Lassen A.T. et. al. , Gut 2004, 53, 1758 – 1763.

What's new in treatment of the infection?

•  Density of H. pylori correlated with high 13 C UBT readings and adverse outcome of eradication therapy in patients with active duodenal ulcers. Lai Y.C. et. al. , World J Gastroenterol , 2004 Apr 1, 10(7), 991 – 4.

•  In the United Kingsdom, 57% of treated patients still exhibit substantial symptoms for 3 – 12 months after eradication of H. pylori . Moayyedi P. et. al ., British Medical J 2000, 321, 649–64.

•  H. pylori were observed to enter and exit the vacuoles of gastric (and other) epithelial cells, seemingly to avoid pulse-administered antibiotics. This could explain the difficulties in eradicating this infection. Amieva M.R. et. al ., Cell Microbiol . 2002 Oct., 4(10), 677 – 90.

•  Carriers were shown to have multiple strains of H. pylori in Thailand and Venezuela . Vilaichone R.K. et. al ., Helicobacter 2004 Oct., 9(5), 453 – 9. Ghose C. et. al. , J of Clinical Microbiology , June 2005, 2635 – 2641.

•  After failure of two eradication treatments, culturing and antibiotic sensitivity testing may not be necessary since several empirical “rescue therapies” had a similar success rate. Gisbert J.P. et. al ., Dig Liver Dis. 2004 Jan., 36(1), 7 – 12.

What's new in the medical aspects of the infection?

•  Blood pressure values were significantly improved in hypertensive patients after eradication of H. pylori . Migneco A. et. al ., Helicobacter . 2003 Dec., 8(6), 585 – 9.

•  Regarding cancer risk, DNA damage in the gastric epithelial cells was directly associated with H. pylori infection, intensity of gastritis and patient age. Marcelo S.P. et. al. , Cancer Epidemiology Biomarkers & Prevention , Vol 13, 631 – 637, April 2004.

Disclaimer: The above is for Information only, and is not intended as medical advice which must be provided by a medical doctor.