Volume 65 - 2002 - Fasc.2 - Original articles
Usefulness of the Helicobacter pylori stool antigen test for detection Helicobacter pylori infection
Several diagnostic tests are available for evaluating Helicobacter pylori (H.pylori) infection : histological examination, culture of gastric biopsy specimens, rapid urease test, urea breath test and serology. In this study, we assessed the reliability of a newly devel- oped enzyme immunoassay HpSA (H. pylori Stool Antigen) kit for detecting H. pylori antigen in stool. Eighty-five patients (50 males, 35 females ; mean age 41.6 ± 9.8 years) with dyspeptic symptoms who were examined by upper gastrointestinal endoscopy. The patients with a history of previous treatment with proton pump inhibitors, bismuth compounds or antibiotics were excluded. During the endoscopic examination biopsies were taken from antrum and corpus for rapid urease test and histological examina- tion. Stool specimens were submitted to the laboratory and HpSA test was performed. H. pylori was considered in condition with rapid urease test and histopathological examination for H. pylori positive. Fourty-six of 85 patients were positive and remaining 39 patients were negative for H. pylori with the rapid urease test and pathologic evaluation. When 0.160 was adopted as the cut-off value, in accordance with the manufacturer's recommendations ; stool antigen has been detected in 45 of the 46 H.pylori positive patients. The sensitivity and specificity of HpSA test were 97.8%, 94.9% respectively.
These results indicate that HpSA is a highly reliable diagnostic method for H. pylori infection. (Acta gastroenterol. belg., 2002, 65, 74-76).
Observational survey of NSAID-related upper gastro-intestinal adverse events in Belgium
Objectives : To evaluate the impact of NSAID use on current routine upper GI endoscopy (UGIE) and to compare the lesions found in NSAID users and non-users.
Methods : Participating gastroenterologists consecutively docu- mented outpatients with and without suspicion of bleeding, referred for upper gastrointestinal endoscopy. Patient characteris- tics, presence of risk factors, NSAID use and endoscopic findings were reported on standard data collection forms.
Main results : A total of 2685 non-bleeding and 159 bleeding patients were enrolled within a time period of 2 months. NSAID therapy was present in 20% of the non-bleeding patients and at least 9% of referrals for endoscopy were directly related to sus- pected NSAID adverse events. Nearly half of acute bleeding patients (42%) were NSAID users, including aspirin for cardio- prevention. Warning digestive symptoms prior to acute bleeding were frequently absent (56%). oesophagitis was the main endo- scopic diagnosis (51% of patients). Gastroduodenal (GD) ulcer was significantly more frequent in NSAID users, whereas oesophagitis and bleeding oesophageal varices were more frequent among non-users. Analysis of odds ratio's demonstrated NSAID use to significantly increase the risk for gastric ulcer in the whole patient group (OR = 2.73 ; 95% confidence interval (CI) : 1.98- 3.77 ; p < 0.001) and, in addition, for duodenal ulcer in the elderly (>65y) subgroup (OR = 2.91 ; 95% CI : 1.52-5.59 ; p < 0.05).
Conclusions : This survey confirms the high incidence of GD ulcers in NSAID users and the risk for serious gastrointestinal complications, often occurring without warning symptoms. It underlines the impact of NSAID use on the routine endoscopy load, the necessity of careful selection of patients for NSAID pre- scriptions and the need for gastropreventive measures, particular- ly in elderly patients and patients associating multiple risk factors. (Acta gastroenterol. belg., 2002, 65, 65-73).
