engleski

Serologic screening before endoscopy: the value of serum recognition of the Helicobacter pylori CagA protein in patients up to 45 years of age

BACKGROUND: We wanted to assess the diagnostic value of pre-endoscopy screening by Helicobacter pylori serum recognition of the CagA in patients up to 45 years of age with uncomplicated simple dyspepsia. METHODS: In a group of dyspeptic patients referred for endoscopy, excluding patients with alarm symptoms or ealier eradication therapy, H. pylori status was determined by histology, microbiology, and serology. H. pylori serologic status and serum recognition of CagA was determined by the Western blot method. RESULTS: 207 H. pylori positive patients (by mean of positive hystology, mycrobiology and serology) were studied (range: 18-88 years). 58/207 were younger or equal to 45 years of age and 149 older than 45 years of age. The sensitivity (specificity) of Western blot in determining H. pylori status was 100% (100%), respectively (gold standard microbiology, histology positive). On endoscopy 45/58 dyspeptic patients younger than 45 years (77.5%) had significant gastroduodenal lesions (ulcers, cancer or severe precancerous lesions on hystology-atrophia or intestinal metaplasia). Screening strategies based solely on serum recognition of the CagA protein would have detected 91.7% of significant lesions. Unfortunately 1 carcionoma and 3 duodenal ulcer wolud been missed. Screening by CagA serology plus anamnesis of NSAIL intake would not increase percentage of detected severe lesions. CONCLUSIONS: In H. pylori positive patients (detected by non invasive methods) with uncomplicated, simple dyspepsia up to 45 years of age, aditional screening for endoscopy solely by CagA serology identified 91.7% of significant gastroduodenal lesions (peptic ulcer, atrofic gastritis, intestinal metaplasia, or malignancy). History of nonsteroidal anti-inflammatory drug use did not change the percentage of recognized significant gastroduodenal lesions. A remarkable share of major pathologies is missed by this screening method. Anti-CagA antibodies do not offer advantages in screening of younger patients for severe gastroduodenal lesions refferd for endoscopy. Therefore, the results of this non invasive screening test is not recommended as only selective criteria for endoscopy in H. pylori positive dyspeptic patients up to 45 years of age.

Helicobacter pylori; serology; CAGA

nije evidentirano