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
Recently, a new diagnostic method based on the detection of Helicobacter pyloriantigen in stools (HpSA) has been developed. Our aim was to prospectively evaluate the accuracyof HpSA both in the initial diagnosis of H. pylori infection and in the confirmation of theeradication after treatment.
Patients and method
Thirty dyspeptic patients were prospectively evaluated. During endoscopy,biopsies for histology and rapid urease test were obtained, and a 13C-urea breath test was performed.HpSA was determined by radioimmunoassay (Premier Platinum HpSA). Infected patientswere administered H. pylori eradication treatment, and breath test and HpSA were performedagain 4 weeks after finishing the therapy. Gold standard for H. pylori infectionpre-treatment was based on rapid urease test, histology and breath test, whereas 13C-urea breathtest was considered the post-treatment gold standard.
Pre-treatment H. pylori prevalence was 57%. Eradication was achieved in 85% of patients.The area under ROC curve for HpSA pre-treatment was 0.98. Cut-off points with bestpre-treatment diagnostic accuracy were those between 0.10 and 0.12: positive likelihood ratio(LR), ∞; negative LR, 0.06; 94% sensitivity (95% CI, 73-99%), 100% specificity (75-100%),100% positive predictive value (81-100%) and 93% negative predictive value (66-100%). Aftertreatment, the area under ROC curve was 1, and all cut-off points between 0.10 and 0.18had 100% diagnostic accuracy. HpSA levels decreased from 0.94 (0.9) to 0.08 (0.02) (p < 0.01) in patients with H. pylori eradication success.
HpSA test can be considered an accurate, non-invasive method for the diagnosisof H. pylori infection both in untreated patients and in the confirmation of H. pylori eradicationafter treatment.
Article: The management of rosacea.[show abstract] [hide abstract]
ABSTRACT: Rosacea is a multiphasic disease which is associated with flushing, erythrosis, papulopustular rosacea and phymas; each phase is likely to have its own treatment. Flushing is better prevented rather than treated, and its etiology investigated. Beta-blockers, atenolol in particular, are worthy of prophylactic trials examining their efficacy in treating the flushing associated with rosacea. Currently, clonidine is the only drug available for the treatment of flushing. Treatment for erythrosis includes topical and systemic therapies. Metronidazole 1% cream and azelaic acid 20% cream have been reported to reduce the severity score of erythema. The systemic treatment of erythrosis is based on the association of Helicobacter pylori with rosacea. However, this role is still being debated. Eradication of H. pylori can be achieved using a triple therapy regimen lasting 1 to 2 weeks [omeprazole and a combination of two antibacterials (a choice from clarithromycin, metronidazole or amoxicillin)]. Both the flashlamp-pumped long-pulse dye laser and the potassium-titanyl-phosphate laser may be used in the treatment of facial telangiectases. Both systemic and topical remedies may be used to treat the papulopustules of rosacea. Systemic treatment includes metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical treatment is based on metronidazole cream and gel. The presence of Demodex folliculorum is important in the inflammatory reaction, whether it is pathogenetic or not. Crotamiton 10% cream or permethrin 5% cream may be useful medications for papulopustular rosacea, although they are rarely successful in eradicating D. folliculorum. Oral or topical ivermectin may also be useful in such cases. Ocular involvement is common in patients with cutaneous rosacea and can be treated with orally administered or topical antibacterials. Once rhinophyma starts to be evident, the only way to correct it is by aggressive dermatosurgical procedures. Decortication and various types of lasers can also be used. Associated conditions, such as seborrheic dermatitis and possible contact sensitizations, deserve attention.American Journal of Clinical Dermatology 02/2002; 3(7):489-96. · 1.84 Impact Factor