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      Molecular technique for detection and identification of Helicobacter pylori in clinical specimens: a comparison with the classical diagnostic method Translated title: Técnica molecular para detecção e identificação de Helicobacter pylori em espécimes clínicas: comparação com o método clássico de diagnóstico

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          Abstract

          ABSTRACT Introduction: Helicobacter pylori is a bacterium found in human epithelial cells of the gastrointestinal tract. Its infection is related to different diseases, such as chronic gastritis, peptic ulcers, gastric lymphoma and adenocarcinoma. The infection by H. pylori is present in more than a half of the world population. Objectives: To detect H. pylori and to compare the diagnostic methods of the rapid urease test (RUT) and polymerase chain reaction (PCR). Materials and methods: The study was conducted between April and July, 2015. For such, three biopsies were collected from each patient. Two were used for PCR and one for RUT. Results: A total of 85 samples were collected from patients undergoing endoscopy, with 56 (65.88%) females and 29 (34.11%) males. From the total samples subjected to RUT, 15 (17.64%) were positive and 70 (82.35%), negative. In PCR for detection of gene 16S ribosomal ribonucleic acid (rRNA) of H. pylori, 66 (77.64%) presented positive results and 19 (22.35%), negative results. For the analysis of the presence of UreA gene in all samples, positive results were found in 70 (82.35%), and negative in 15 (17.64%). According to the results, RUT and the molecular test presented statistical difference. Conclusion: PCR is a useful method in the laboratorial routine to detect the presence of H. pylori in the stomach tissue, due to high sensitivity and specificity, but it requires a more careful analysis and standardization.

          Translated abstract

          RESUMO Introdução: Helicobacter pylori é uma bactéria encontrada nas células epiteliais do trato gastrointestinal humano. Sua infecção relaciona-se com diferentes patologias, como gastrite crônica, úlcera péptica, linfoma gástrico e adenocarcinoma. A infecção por Helicobacter pylori está presente em mais da metade da população mundial. Objetivos: Detectar a presença de H. pylori e comparar os métodos diagnósticos do teste rápido de urease (TRU) e reação em cadeia da polimerase (PCR). Materiais e métodos: No estudo, realizado entre abril e julho de 2015, três biópsias foram coletadas de cada paciente. Duas foram usadas para realizar PCR e uma, para TRU. Resultados: Oitenta e cinco amostras foram coletadas dos pacientes por meio de endoscopia, sendo 56 (65,88%) mulheres e 29 (34,11%) homens. Do total dos indivíduos sujeitos ao TRU, 15 (17,64%) foram positivos e 70 (82,35%), negativos. Na PCR, na detecção do gene 16S ácido ribonucleico ribossômico (rRNA) de H. pylori, 66 (77,64%) apresentaram resultados positivos e 19 (22,35%), negativos. Para a análise da presença do gene UreA em todas as amostras, resultados positivos foram encontrados em 70 (82,35%) e negativos em 15 (17,64%). De acordo com os resultados, o TRU e o teste molecular apresentaram diferenças estatísticas. Conclusão: A PCR é um método útil na rotina laboratorial para detectar H. pylori em tecido de estômago devido à sua alta sensibilidade e especificidade, mas é necessária maior atenção na análise e na padronização.

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          A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication.

          Helicobacter pylori (H. pylori) affects nearly half of the world's population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient's clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.
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            Diagnosis of Helicobacter pylori using the rapid urease test.

            Helicobacter pylori (H. pylori) is a major human pathogen which causes progressive gastroduodenal damage. Guidelines recommend that, unless there are compelling reasons to delay, treatment is indicated for all patients in whom the infection is diagnosed. The rapid urease test (RUT) is a popular diagnostic test in that it is a rapid, cheap and simple test that detects the presence of urease in or on the gastric mucosa. The sensitivity and specificity are generally high and many versions have been approved for use in humans. Best results are obtained if biopsies are obtained from both the antrum and corpus. The tissue sample embedded in the RUT gel can also be utilized for other tests such as for molecular based tests of microbial susceptibility or for host factors. False-positive results are rare if the RUT contains an antibacterial agent to prevent growth of urease-containing contaminants and the tests are discarded at 24 hours. The use of antimicrobial drugs and proton pump inhibitors as well as the presence of intestinal metaplasia may result in false-negative results. A negative test should not be used as the criteria for cure or in cases where accuracy is important for patient management such as in upper gastrointestinal bleeding. Interpretation of the test should take into account the pretest probability and the prevalence of H. pylori in the population. The test can also be used to provide an informal assessment of the accuracy of the histopathology result and discrepancies should prompt a review of the histopathology and discussions with the pathologist.
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              Diagnostic Methods of Helicobacter pylori Infection for Epidemiological Studies: Critical Importance of Indirect Test Validation

              Among the methods developed to detect H. pylori infection, determining the gold standard remains debatable, especially for epidemiological studies. Due to the decreasing sensitivity of direct diagnostic tests (histopathology and/or immunohistochemistry [IHC], rapid urease test [RUT], and culture), several indirect tests, including antibody-based tests (serology and urine test), urea breath test (UBT), and stool antigen test (SAT) have been developed to diagnose H. pylori infection. Among the indirect tests, UBT and SAT became the best methods to determine active infection. While antibody-based tests, especially serology, are widely available and relatively sensitive, their specificity is low. Guidelines indicated that no single test can be considered as the gold standard for the diagnosis of H. pylori infection and that one should consider the method's advantages and disadvantages. Based on four epidemiological studies, culture and RUT present a sensitivity of 74.2–90.8% and 83.3–86.9% and a specificity of 97.7–98.8% and 95.1–97.2%, respectively, when using IHC as a gold standard. The sensitivity of serology is quite high, but that of the urine test was lower compared with that of the other methods. Thus, indirect test validation is important although some commercial kits propose universal cut-off values.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jbpml
                Jornal Brasileiro de Patologia e Medicina Laboratorial
                J. Bras. Patol. Med. Lab.
                Sociedade Brasileira de Patologia Clínica; Sociedade Brasileira de Patologia; Sociedade Brasileira de Citopatologia (Rio de Janeiro, RJ, Brazil )
                1678-4774
                February 2017
                : 53
                : 1
                : 13-19
                Affiliations
                [2] Goiás orgnameFaculdade Alfredo Nasser Brazil
                [1] Goiás orgnameUniversidade Federal de Goiás Brazil
                Article
                S1676-24442017000100013
                10.5935/1676-2444.20170003
                306ed8b5-b423-478f-96e2-5d2998ab0ab8

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 13 September 2016
                : 03 November 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 7
                Product

                SciELO Brazil


                bactérias,reação em cadeia da polimerase,urease,bacteria,polymerase chain reaction

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