Gastric juice-based PCR assay: An alternative testing method to aid in the management of previously treated Helicobacter pylori infection.
Anti-Bacterial Agents
/ pharmacology
Bacterial Load
Biopsy
Clarithromycin
/ pharmacology
Drug Resistance, Bacterial
Female
Gastric Juice
/ microbiology
Helicobacter Infections
/ diagnosis
Helicobacter pylori
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Polymerase Chain Reaction
Polymorphism, Restriction Fragment Length
Sensitivity and Specificity
Stomach
/ microbiology
Treatment Failure
culture
gastric juice PCR
previously treated H. pylori
Journal
Helicobacter
ISSN: 1523-5378
Titre abrégé: Helicobacter
Pays: England
ID NLM: 9605411
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
01
11
2018
revised:
01
01
2019
accepted:
03
01
2019
pubmed:
2
3
2019
medline:
26
7
2019
entrez:
2
3
2019
Statut:
ppublish
Résumé
Culture of Helicobacter pylori with previous eradication failure has been emphasized in clinical guidelines. The current unmet need to manage previously treated H pylori is one tool with diagnostic accuracy and ability for antibiotics susceptibility. Gastric juice PCR can provide diagnosis and antibiotics susceptibility; however, whether treatment failure affects its accuracy remains uninvestigated. Our study aimed to investigate diagnostic accuracy and antibiotics susceptibility of juice PCR in previously treated H pylori and to compare with the current standard of culture. We categorized all 547 patients into treatment-naïve, post-1st treatment, post-2nd treatment, and post-3rd treatment. Helicobacter pylori infection was confirmed using gold standards. Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic (ROC) curve and area under ROC curve (AUC) of juice PCR and culture were calculated. Intra-gastric H pylori density was evaluated. Lastly, the antibiotics susceptibility results of gastric juice and culture were compared. Our findings demonstrated AUC was higher in juice PCR than culture in all patients (96.7% vs 91.3%, P < 0.0001). The superiority of juice PCR was statistically significant in previously treated patients (P < 0.0001) but not in treatment-naïve patients (P = 0.13). Antral H pylori density was less marked in previously treated patients (P = 0.014). The comparisons of PCR-RFLP and E-test for Clarithromycin resistance showed reliable AUC = 89.8%. Compared with the current standard of culture, the gastric juice PCR contains the strengths of performing the antibiotics susceptibility and overcomes the shortcomings of low accuracy. Consequently, gastric juice PCR suits the unmet need to manage previously treated H pylori.
Sections du résumé
BACKGROUND
BACKGROUND
Culture of Helicobacter pylori with previous eradication failure has been emphasized in clinical guidelines. The current unmet need to manage previously treated H pylori is one tool with diagnostic accuracy and ability for antibiotics susceptibility. Gastric juice PCR can provide diagnosis and antibiotics susceptibility; however, whether treatment failure affects its accuracy remains uninvestigated. Our study aimed to investigate diagnostic accuracy and antibiotics susceptibility of juice PCR in previously treated H pylori and to compare with the current standard of culture.
METHODS
METHODS
We categorized all 547 patients into treatment-naïve, post-1st treatment, post-2nd treatment, and post-3rd treatment. Helicobacter pylori infection was confirmed using gold standards. Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic (ROC) curve and area under ROC curve (AUC) of juice PCR and culture were calculated. Intra-gastric H pylori density was evaluated. Lastly, the antibiotics susceptibility results of gastric juice and culture were compared.
RESULTS
RESULTS
Our findings demonstrated AUC was higher in juice PCR than culture in all patients (96.7% vs 91.3%, P < 0.0001). The superiority of juice PCR was statistically significant in previously treated patients (P < 0.0001) but not in treatment-naïve patients (P = 0.13). Antral H pylori density was less marked in previously treated patients (P = 0.014). The comparisons of PCR-RFLP and E-test for Clarithromycin resistance showed reliable AUC = 89.8%.
CONCLUSION
CONCLUSIONS
Compared with the current standard of culture, the gastric juice PCR contains the strengths of performing the antibiotics susceptibility and overcomes the shortcomings of low accuracy. Consequently, gastric juice PCR suits the unmet need to manage previously treated H pylori.
Substances chimiques
Anti-Bacterial Agents
0
Clarithromycin
H1250JIK0A
Types de publication
Journal Article
Langues
eng
Pagination
e12568Subventions
Organisme : Kaohsiung Medical University Aim for the Top Universities Grant
ID : KMU-TP105-G00
Organisme : Kaohsiung Medical University Aim for the Top Universities Grant
ID : KMU-TP105G01
Organisme : Kaohsiung Medical University
ID : KMU-M103020
Organisme : Kaohsiung Medical University
ID : KMU-DK107006
Organisme : Kaohsiung Medical University Hospital
ID : KMUH106-6M01
Organisme : Kaohsiung Medical University Hospital
ID : KMUH106-6R02
Informations de copyright
© 2019 John Wiley & Sons Ltd.