- Email: [email protected]
M1057 1 Minute Urea Ultrafast-Test for Helicobacter pylori (H Pylori) Diagnosis
58.7%, 42.7%, respectively. There was a positive correlation between H. pylori positivity and duodenal ulcer (r=0.159, p<0.000) but not in gastric ulcer. H. pylori positivity rate was 66.9% and 50.3% in duodenal ulcer and gastric ulcer, respectively in all patients. Conclusion: Over the past two decade, peptic ulcer prevalence has been decreased. However, the presentation of gastric ulcer in elderly is still significantly higher compared to young population. The prevalence of H. pylori was statistically significantly lower in last 5 years.
M1059
Introduction: Ambulatory pts with GI Sx are treated with PPI's and scheduled for EGD. EGD is mostly normal, Sx have disappeared and biopsies are rare. The wisdom of searching for HP-inf is controversial. Purpose: To determine the long-term outcomes of Pts with and without HP-inf who have undergone EGD for any indication at our VA Hospital. Methods: The “At-Risk Study Group” comprised ambulatory outpts who had EGD at any time during a 4-yr Recruitment Period (RP) from Jan 1998 through Dec 2001. The group was formed from 2 time periods: (1) those whose initial EGD occurred in the years before the 4-year RP but who required a repeat EGD within the RP; and (2) those whose initial EGD occurred within the RP and then required a repeat EGD (or hospitalization) after the RP. The paper and electronic records of these Pts were reviewed in detail to determine whether the need for the latter scope resulted from an undiagnosed/untreated HP-inf. Definitions of Outcomes: (1) Minor Bad: repeated EGDs for GI Sx. (2) Major Bad: the need for hospitalization for ulcer bleeding, gastric MALT or gastric AdCa. (3) Neutral: minimal Sx or the need for PPI's, HRAs or antacids, but not hospitalization. Results: The “At-Risk Study Group” comprised 1207 pts: 407 have known outcomes; 800 remain in the holding bin. F/U ranged from 1 to 18 years with a mean duration of 6.3 years. HP-Pos pts had worse outcomes in every parameter tested. KM survival showed that untreated HP-inf increased the risk of Major Comp 3.3-fold (Hazard Ratio=0.3; CI: 0.2-0.4; P<0.0001) and of All Comps (Major and Minor) 5.6-fold. Multiple Regression showed that Age at initial EGD, NSAID's, HRA's and PPI's were not related to outcome. Conclusion: Pts undergoing EGD who have HP-inf that remains undiagnosed and untreated have a higher likelihood of a GI Comp in the future than Pts with HP-Neg-inf or HP-Pos-inf that was successfully treated.
M1057 1 Minute Urea Ultrafast-Test for Helicobacter pylori (H Pylori) Diagnosis Federico Perna, Ilaria M. Saracino, Chiara Ricci, Dino Vaira BACKGROUND: Rapid Urease Test (RUT) is a well-known accurate and cheap test for H pylori, although its actual usefulness is linked to the feasibility to be checked in the endoscopy room soon after endoscopy: most RUTs may need up to 24 hours “waiting time” for the diagnosis and need for the patient to come back the day after endoscopy. Recently, a new urea ultrafast-test has been made commercially available (ABS; Cernusco, Milan, Italy), which claims 1 minute to diagnose H. pylori at room temperature. AIM: To assess the accuracy and the reaction time of the urea ultrafast-test, for diagnosing H. pylori infection. METHODS: A total of 357 untreated consecutive naïve patients with upper GI symptoms were enrolled (m/f: 146/211, age-range: 20-87 yrs). At endoscopy, four biopsy samples were obtained for: histology (n=2), culture (n=1) and one for the urea ultrafast-test. Before endoscopy all the patients underwent 13C-urea breath test. RESULTS: One hundred and seventy-one out of 357 (47.8%) untreated dyspeptic patients were found to be positive and therefore defined as H pylori infection infected. Endoscopic findings were: 42 duodenal ulcers, 2 gastric ulcer; 269 antral gastritis; 19 Barrett oesophagus; 24 oesophagitis; 1 oesophageal cancer. Results are shown in the table. One hundred and sixty-six out of 171 H pylori positive were positive according to urea ultrafast- test and all 186 H pylori negative patients were negative. One hundred and sixty patients were positive within 1 minute; three patients within 5, two patients within 30, one patient only within 60 minutes. All 186 negative patients were negative after 24 hours. Sensitivity for the urea ultrafast-test was 97%; the specificity was 100%. CONCLUSION: The urea ultrafast-test seems to be the real test to be used, in the endoscopy room, for the management of H. pylori infection
M1060 Rapid and Superior Diagnosis of H. pylori Infection By 14C-Urea HeliprobeTM Test Versus the PYtest® Thomas J. Borody, Antony R. Wettstein, Jordana Campbell, Margaux Torres, Lauren A. Hills, Kylie J. Herdman, Gerald Pang, Sanjay Ramrakha Background: Endoscopic histological examination is considered the current gold standard for diagnosis of Helicobacter pylori (H. pylori) infection but is invasive, expensive and carries a small but definite risk. 14C-urea breath test (UBT) is a highly sensitive and specific test for diagnosis of H. pylori infection but the available tests are time-consuming, expensive and not portable. The novel HeliprobeTM UBT system consists of a urea capsule, a slim breath ‘card' and a small, solid-state detector reading the result in 4 minutes. Aim: To compare the sensitivity, specificity, positive and negative predictive values and accuracy of the rapid, point-of-care 14C-urea breath test HeliprobeTM with the conventional PYtest®. Methods: H. pylori testing using HeliprobeTM and PYtest® was performed in 119 consecutive patients (58 M: 61 F, mean age, 48.9 + 12.5 yrs mean age 49.3 + 12.6 yrs respectively) with dyspeptic symptoms undergoing gastroscopy. The new HeliprobeTM UBT system consisted of a breath ‘card‘ device to absorb CO2 and a portable analyser. Patients were randomised to either HeliprobeTM or PYtest® UBT test for H. pylori at baseline then followed up at 10-12 days and re-tested in a ‘cross-over' fashion with the other device. H. pylori infection was confirmed by biopsy tests including rapid urease test (RUT) and histology. This was an Ethics Committee approved clinical trial. Results: H. pylori infection was diagnosed by histology and by RUT in 49 (41%) patients. HeliprobeTM detected active H. pylori infection in 49 (41%) patients while PYtest® detected infection in 44 (37%) patients. The diagnostic values of HeliprobeTM versus PYtest® using RUT and histology as a reference standard were: sensitivity 98% (CI 89-99%) vs 86% (CI 73-94%) (P=0.0001), specificity 100% (CI 94100%) vs 97% (CI 89-99%), positive predictive value 100% (CI 93-100%) vs 96% (CI 8699%), negative predictive value 98% (CI 92-99) vs 97% (CI 89-99%) and accuracy 99%(CI 95-100%) vs 93% (CI 87-97%) (P=0.0001), for HeliprobeTM and PYtest®, respectively. The results of the kappa test showed a stronger agreement with the reference standard for HeliprobeTM (kappa=0.97) than for PYtest® (kappa= 0.810) (P=0.0001). Conclusion: The portable 14C-urea breath test HeliprobeTM is more accurate, reliable and simpler to use for the diagnosis of H. pylori infection than the PYtest®. In this study it was equivalent to the endoscopic gold standard, making it ideal for routine clinical practice.
M1058 Helicobacter pylori Recurrence in Developed and Developing Countries: MetaAnalysis of 13c-Urea Breath Test Follow-Up After Eradication Yaron Niv, Rachel Hazazi Objective: Recurrence of Helicobacter pylori after eradication is rare in developed countries and more frequent in developing countries. Most recurrent cases are attributed to recrudescence (recolonization of the same strain within 12 months) rather than to reinfection (colonization with a new strain after more than 12 months). The aim of the study was to analyze recurrence rates in developed and developing countries and to deduce the relative roles of recrudescence and reinfection. Methods: The PubMed database was searched up to January 31, 2007 using the keywords “Helicobacter pylori” or “H. pylori” and “recurrence” or “recrudescence” or “reinfection”. Only prospective case studies in adults that used the 13C- urea breath test (13CUBT) were included. Meta-analyses were performed with StatDirect Statistical software, version 2.6.1. Results: The literature search yielded 10 studies of H. pylori recurrence in developed countries (3014 patients followed for 24-60 months) and 7 studies in developing countries (2071 patients followed for 12-60 months). The calculated annual recurrence rates were 2.67% and 13.00%, respectively. Nested meta-analysis of cases with a longer followup after eradication revealed an annual recurrence rate of 1.45% (RR 0.54) in developed countries and 12.00% (RR 0.92) in developing countries. Conclusions: The similarity of the annual recurrence rates during the first year after eradication and the annual recurrence rates in the second year after successful eradication in developing countries supports reinfection as the main cause in the second period. Therefore, a different approach for follow-up of H. pylori eradication may be needed between developed and developing countries.
A-329
AGA Abstracts
AGA Abstracts
Helicobacter pylori Infection Not Diagnosed At Endoscopy: Long-Term Outcomes Stephen J. Sontag, Kapil Mehta, Thomas G. Schnell, Jack Leya, GI Fellows Hines-Loyola
M1059
Introduction: Ambulatory pts with GI Sx are treated with PPI's and scheduled for EGD. EGD is mostly normal, Sx have disappeared and biopsies are rare. The wisdom of searching for HP-inf is controversial. Purpose: To determine the long-term outcomes of Pts with and without HP-inf who have undergone EGD for any indication at our VA Hospital. Methods: The “At-Risk Study Group” comprised ambulatory outpts who had EGD at any time during a 4-yr Recruitment Period (RP) from Jan 1998 through Dec 2001. The group was formed from 2 time periods: (1) those whose initial EGD occurred in the years before the 4-year RP but who required a repeat EGD within the RP; and (2) those whose initial EGD occurred within the RP and then required a repeat EGD (or hospitalization) after the RP. The paper and electronic records of these Pts were reviewed in detail to determine whether the need for the latter scope resulted from an undiagnosed/untreated HP-inf. Definitions of Outcomes: (1) Minor Bad: repeated EGDs for GI Sx. (2) Major Bad: the need for hospitalization for ulcer bleeding, gastric MALT or gastric AdCa. (3) Neutral: minimal Sx or the need for PPI's, HRAs or antacids, but not hospitalization. Results: The “At-Risk Study Group” comprised 1207 pts: 407 have known outcomes; 800 remain in the holding bin. F/U ranged from 1 to 18 years with a mean duration of 6.3 years. HP-Pos pts had worse outcomes in every parameter tested. KM survival showed that untreated HP-inf increased the risk of Major Comp 3.3-fold (Hazard Ratio=0.3; CI: 0.2-0.4; P<0.0001) and of All Comps (Major and Minor) 5.6-fold. Multiple Regression showed that Age at initial EGD, NSAID's, HRA's and PPI's were not related to outcome. Conclusion: Pts undergoing EGD who have HP-inf that remains undiagnosed and untreated have a higher likelihood of a GI Comp in the future than Pts with HP-Neg-inf or HP-Pos-inf that was successfully treated.
M1057 1 Minute Urea Ultrafast-Test for Helicobacter pylori (H Pylori) Diagnosis Federico Perna, Ilaria M. Saracino, Chiara Ricci, Dino Vaira BACKGROUND: Rapid Urease Test (RUT) is a well-known accurate and cheap test for H pylori, although its actual usefulness is linked to the feasibility to be checked in the endoscopy room soon after endoscopy: most RUTs may need up to 24 hours “waiting time” for the diagnosis and need for the patient to come back the day after endoscopy. Recently, a new urea ultrafast-test has been made commercially available (ABS; Cernusco, Milan, Italy), which claims 1 minute to diagnose H. pylori at room temperature. AIM: To assess the accuracy and the reaction time of the urea ultrafast-test, for diagnosing H. pylori infection. METHODS: A total of 357 untreated consecutive naïve patients with upper GI symptoms were enrolled (m/f: 146/211, age-range: 20-87 yrs). At endoscopy, four biopsy samples were obtained for: histology (n=2), culture (n=1) and one for the urea ultrafast-test. Before endoscopy all the patients underwent 13C-urea breath test. RESULTS: One hundred and seventy-one out of 357 (47.8%) untreated dyspeptic patients were found to be positive and therefore defined as H pylori infection infected. Endoscopic findings were: 42 duodenal ulcers, 2 gastric ulcer; 269 antral gastritis; 19 Barrett oesophagus; 24 oesophagitis; 1 oesophageal cancer. Results are shown in the table. One hundred and sixty-six out of 171 H pylori positive were positive according to urea ultrafast- test and all 186 H pylori negative patients were negative. One hundred and sixty patients were positive within 1 minute; three patients within 5, two patients within 30, one patient only within 60 minutes. All 186 negative patients were negative after 24 hours. Sensitivity for the urea ultrafast-test was 97%; the specificity was 100%. CONCLUSION: The urea ultrafast-test seems to be the real test to be used, in the endoscopy room, for the management of H. pylori infection
M1060 Rapid and Superior Diagnosis of H. pylori Infection By 14C-Urea HeliprobeTM Test Versus the PYtest® Thomas J. Borody, Antony R. Wettstein, Jordana Campbell, Margaux Torres, Lauren A. Hills, Kylie J. Herdman, Gerald Pang, Sanjay Ramrakha Background: Endoscopic histological examination is considered the current gold standard for diagnosis of Helicobacter pylori (H. pylori) infection but is invasive, expensive and carries a small but definite risk. 14C-urea breath test (UBT) is a highly sensitive and specific test for diagnosis of H. pylori infection but the available tests are time-consuming, expensive and not portable. The novel HeliprobeTM UBT system consists of a urea capsule, a slim breath ‘card' and a small, solid-state detector reading the result in 4 minutes. Aim: To compare the sensitivity, specificity, positive and negative predictive values and accuracy of the rapid, point-of-care 14C-urea breath test HeliprobeTM with the conventional PYtest®. Methods: H. pylori testing using HeliprobeTM and PYtest® was performed in 119 consecutive patients (58 M: 61 F, mean age, 48.9 + 12.5 yrs mean age 49.3 + 12.6 yrs respectively) with dyspeptic symptoms undergoing gastroscopy. The new HeliprobeTM UBT system consisted of a breath ‘card‘ device to absorb CO2 and a portable analyser. Patients were randomised to either HeliprobeTM or PYtest® UBT test for H. pylori at baseline then followed up at 10-12 days and re-tested in a ‘cross-over' fashion with the other device. H. pylori infection was confirmed by biopsy tests including rapid urease test (RUT) and histology. This was an Ethics Committee approved clinical trial. Results: H. pylori infection was diagnosed by histology and by RUT in 49 (41%) patients. HeliprobeTM detected active H. pylori infection in 49 (41%) patients while PYtest® detected infection in 44 (37%) patients. The diagnostic values of HeliprobeTM versus PYtest® using RUT and histology as a reference standard were: sensitivity 98% (CI 89-99%) vs 86% (CI 73-94%) (P=0.0001), specificity 100% (CI 94100%) vs 97% (CI 89-99%), positive predictive value 100% (CI 93-100%) vs 96% (CI 8699%), negative predictive value 98% (CI 92-99) vs 97% (CI 89-99%) and accuracy 99%(CI 95-100%) vs 93% (CI 87-97%) (P=0.0001), for HeliprobeTM and PYtest®, respectively. The results of the kappa test showed a stronger agreement with the reference standard for HeliprobeTM (kappa=0.97) than for PYtest® (kappa= 0.810) (P=0.0001). Conclusion: The portable 14C-urea breath test HeliprobeTM is more accurate, reliable and simpler to use for the diagnosis of H. pylori infection than the PYtest®. In this study it was equivalent to the endoscopic gold standard, making it ideal for routine clinical practice.
M1058 Helicobacter pylori Recurrence in Developed and Developing Countries: MetaAnalysis of 13c-Urea Breath Test Follow-Up After Eradication Yaron Niv, Rachel Hazazi Objective: Recurrence of Helicobacter pylori after eradication is rare in developed countries and more frequent in developing countries. Most recurrent cases are attributed to recrudescence (recolonization of the same strain within 12 months) rather than to reinfection (colonization with a new strain after more than 12 months). The aim of the study was to analyze recurrence rates in developed and developing countries and to deduce the relative roles of recrudescence and reinfection. Methods: The PubMed database was searched up to January 31, 2007 using the keywords “Helicobacter pylori” or “H. pylori” and “recurrence” or “recrudescence” or “reinfection”. Only prospective case studies in adults that used the 13C- urea breath test (13CUBT) were included. Meta-analyses were performed with StatDirect Statistical software, version 2.6.1. Results: The literature search yielded 10 studies of H. pylori recurrence in developed countries (3014 patients followed for 24-60 months) and 7 studies in developing countries (2071 patients followed for 12-60 months). The calculated annual recurrence rates were 2.67% and 13.00%, respectively. Nested meta-analysis of cases with a longer followup after eradication revealed an annual recurrence rate of 1.45% (RR 0.54) in developed countries and 12.00% (RR 0.92) in developing countries. Conclusions: The similarity of the annual recurrence rates during the first year after eradication and the annual recurrence rates in the second year after successful eradication in developing countries supports reinfection as the main cause in the second period. Therefore, a different approach for follow-up of H. pylori eradication may be needed between developed and developing countries.
A-329
AGA Abstracts
AGA Abstracts
Helicobacter pylori Infection Not Diagnosed At Endoscopy: Long-Term Outcomes Stephen J. Sontag, Kapil Mehta, Thomas G. Schnell, Jack Leya, GI Fellows Hines-Loyola