Helicobacter pylori Infection REPLY

Division of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Glasgow, United Kingdom.
New England Journal of Medicine (Impact Factor: 55.87). 04/2010; 362(17):1597-604. DOI: 10.1056/NEJMcp1001110
Source: PubMed


A 29-year-old man presents with intermittent epigastric discomfort, without weight loss or evidence of gastrointestinal bleeding. He reports no use of aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). Abdominal examination reveals epigastric tenderness. A serologic test for Helicobacter pylori is positive, and he receives a 10-day course of triple therapy (omeprazole, amoxicillin, and clarithromycin). Six weeks later, he returns with the same symptoms. How should his case be further evaluated and managed?

Full-text preview

Available from:
  • Source
    • "the result cannot represent the current infection, as the antibody is still detectable months to years after successful H. pylori eradication [23] [24]. So it raises a concern about the interpretation of the association between disease and H. pylori when the infection is determined by the existence of H. pylori IgG antibody. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Helicobacter pylori (H. pylori) was linked with several extragastrointestinal diseases, including preeclampsia and intrauterine growth restriction of fetus. One of the signals which can be transferred from mother to fetus is the H. pylori IgG antibody. Aims. We utilized a commercial immunochromatographic kit to detect the antibody in maternal and cord serum. Methods: Three hundred and forty-six females were enrolled and the blood samples were collected on antenatal examination and on delivery. The maternal H. pylori infection was determined by stool H. pylori antigen test. Results: One hundred and five females (30.3%) were H. pylori-infected, and the prevalence was higher in immigrants (43.5%) than in Taiwanese (28.7%, P = 0.058). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the kit were 77.1%, 88.0%, 73.6%, 89.8%, and 84.7%, respectively. This kit also had similar performance in cord serum. Comparing to the maternal result on delivery, this kit offered a consistent performance in antenatal maternal serum (kappa coefficient 0.92) and in cord serum (kappa coefficient 0.88). Conclusions: H. pylori IgG antibody can be transferred through the placenta into the fetal circulation. However, accuracy of the test kit needs to be evaluated before utilization in screening.
    BioMed Research International 08/2014; 2014:568410. DOI:10.1155/2014/568410 · 1.58 Impact Factor
  • Source
    • "Helicobacter pylori infection causes chronic gastritis and is associated with an increased risk of upper gastrointestinal diseases, such as peptic ulcer disease, gastric cancer, and mucosa-associated lymphoid tissue lymphoma (1, 2). Although its incidence has declined in developed countries, the prevalence of H. pylori remains high in Korea (3, 4, 5, 6). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea. Graphical Abstract
    Journal of Korean Medical Science 05/2014; 29(5):704-13. DOI:10.3346/jkms.2014.29.5.704 · 1.27 Impact Factor
  • Source
    • "In spite of these facts, spontaneous eradication of these bacteria form human body is very rare. Moreover, the research conducted on animal models suggests, that establishing humoral immunity does not protect against infection [19]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The endospores of Bacillus subtilis are now widely used as a platform for presentation of heterologous proteins and due to their safety record and high resistance to harsh environmental conditions can be considered as potential vehicles for oral vaccination. In this research we show that recombinant B. subtilis spores presenting a fragment of the Helicobacter acinonychis UreB protein and expressing the ureB gene under vegetative promoter elicit a strong cellular immune response in orally immunized mice when co-administered with spores presenting IL-2. We show for the first time the successful application of two types of recombinant spores, one carrying an antigen and the other an adjuvant, in a single oral immunization.
    PLoS ONE 04/2014; 9(4):e95187. DOI:10.1371/journal.pone.0095187 · 3.23 Impact Factor
Show more