engleski

The Value of Serum Recognition of the Helicobacter pylori CagA Protein in Patients up to 45 Years of Age before Endoscopy

Aim. to assess the diagnostic value of pre-endoscopy anti-CagA serum screening of patients up to 45 years of age with uncomplicated simple dyspepsia. Methods. In a group of 207 dyspeptic patients (excluding patients with alarm symptoms or earlier eradication therapy) Helicobacter pylori status was determined by histology, microbiology, and serology. Serum recognition of H. pylori anti-CagA antibodies was determined by the Western blot method. Results. Of 207 (range: 18– 88 years) H. pylori-positive patients, 58/207 were younger or equal and 149 older than 45 years of age. The sensitivity and specificity of Western blot in determining H. pylori status was 100% (gold standard microbiology and histology). Endoscopic findings in 45/58 dyspeptic patients younger than 45 years (77.5%) were significant gastroduodenal lesions (ulcers, cancer, or severe histology changes – atrophy or intestinal metaplasia). Screening strategies based solely on serum recognition of the CagA protein would have detected 91.7% of significant lesions. Unfortunately, one carcinoma and three duodenal ulcers would be 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 noninvasive methods) with uncomplicated simple dyspepsia up to 45 years of age, additional screening for endoscopy solely by CagA serology identified 91.7% of significant gastroduodenal lesions. Therefore, the results of this noninvasive screening test is not recommended as the only selective criteria for endoscopy in H. pylori positive dyspeptic patients up to 45 years of age.

Helicobacter pylori; CagA protein; endoscopy

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