BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions.

/pdf/non-invasive-diagnostic-tests-for-helicobacter-pylori-3vp9t6qcet.pdf

Non-invasive diagnostic tests for Helicobacter pylori infection

Scientific Principles for Evaluating the Potential for Adverse Effects from Chlorinated Organic Chemicals in the Environment

A great variety of drugs, cosmetics, food ingredients as well as environmental contaminants are secreted with human milk as a result of actual exposure or the accumulated body burden of the mother Of great concern and least amenable to short-term intervention are persistent substances in the environment with long half-lives in the body due to their lipophilic properties and minimal degradation Polyhalogenated aromatic hydrocarbons, namely organochlorine pesticides, polychlorinated biphenyls (PCB) and polychlorinated dibenzodioxins (PCDD) and dibenzofurans (PCDF) are fetotoxic, neurotoxic, immunotoxic, some are promoting carcinogens and/or interfere with hormonal receptors They pass the placenta and equilibrate among the lipid compartments of the body including breast milk lipids Transplacental exposure is more relevant with regard to physical development and cognitive functioning of the child than postnatal exposure via breastmilk Restrictions for production, use and release have been successful in decreasing exposure as shown by a downward trend of their contents both in human milk and serum lipids for the last 15 to 20 years It is difficult to evaluate the potentially late effects of the exposure via breastmilk which is 10 to 100 times higher in industrialised countries than the tolerable daily intake (TDI) of 1 to 4 toxic equivalents (WHO-TEQ) pg/kg/day established in 1998 by WHO for dioxins and dioxin-like PCBs but which lasts for 06% of the expected life span only Carefully conducted long-term follow-up of cohorts with defined exposure levels, with consideration of numerous biological and psychological parameters, is expected to provide the answer

Exposition to and health effects of residues in human milk.

Direct analysis of bromide in human serum by capillary electrophoresis

UNLABELLED Until the 1970s, polychlorinated biphenyls (PCB) were used as industrial chemicals for diverse commercial applications, leading to a ubiquitous contamination of nature and man. In the 1980s, PCBs were prohibited by law in many industrialized countries. Hence, in recent years a steady decline in PCB levels has been seen. Here we report on PCB plasma levels in children and adults in Germany in 1998. PARTICIPANTS AND METHODS 130 children/youth (0 to 55 y were as follows: PCB 138: 1.02; 1.05; 0.61; 1.01; 1.22; 1.44; 2.23; 2.94 microg/L plasma; PCB 153: 1.47; 1.23; 0.59; 1.26; 1.53; 2.11; 3.27; 3.98 microg/l plasma; PCB 180: 0.88; 1.23; 0.39; 0.88; 1.16; 1.71; 2.16; 3.31 microg/L. DISCUSSION In adults, plasma levels of PCBs increased with age. In comparison with published reference values on internal PCB exposure in the population in Germany, based on data obtained in 1991/4 and 1994/5, the steady decline in PCB levels reflects the falling external and internal PCB exposure after the ban on PCB. For the first time, current PCB exposure during childhood and adolescence in Germany is provided here. In childhood, internal PCB exposure declined with age, especially in children who had been breastfed. An impact of breastfeeding on internal PCB exposure was found in age groups up to 12 years old.

Polychlorinated Biphenyls in the Blood Plasma: Current Exposure of the Population in Germany

Belastung unserer Kinder mit Pestiziden, PCB und potentiell kristischen Anionen

Fragestellung: Wie haben sich die Konzentrationen der Chlorkohlenwasserstoffe (CKW) im Fettgewebe von Kindern wahrend der letzten 14 Jahre verhalten? Sind noch andere als die bisher bekannten Schadstoffe im Fett abgelagert? Methode: In Fettgewebsproben von 1267 Sauglingen, Kindern und Adoleszenten aus West- und Ostdeutschland sowie aus Saratow, Rusland, wurden die Konzentrationen der CKW mittels Gaschromatographie bzw. Massenspektrometrie quantitativ bestimmt und auf den Fettgehalt bezogen angegeben (µg/kg Fett=ppb). Ergebnisse: Die Konzentrationen der bisher bekannten CKW sind wahrend der letzten Jahre alle stark zuruckgegangen. Es wurden aber auch bisher unbekannte CKW im Fettgewebe entdeckt, namlich 2 Toxaphene (Parlar 26 und 50) in geringer Menge. Schlusfolgerung: Zwar ist die Belastung unserer Kinder mit den bisher bekannten CKW wahrend der letzten Jahre deutlich zuruckgegangen, doch fuhrten empfindlichere Nachweismethoden zum Nachweis bisher unbekannter potentieller Schadstoffe im Fettgewebe, so das eine vollige Entwarnung z.Z. noch nicht gerechtfertigt ist.

Altbekannte Schadstoffe und neuentdeckte Toxaphene im Fettgewebe von Kindern

The anions analysis was a methodical problem up to now. This was the reason for low interest. Biological fluids like saliva and urine which could easily receive without any stress for the children, are little investigated for its capacity on nitrite, nitrate, bromide and sulfate. In this performance there will presented an ion-chromatographic method to determine inorganic anions in the following body-fluids: serum saliva, liquor and urine. The anions chloride, nitrite, bromide, nitrate, phosphate and sulfate was determined quantitatively. The method was proved in a pilot-study on children's body-fluids serum, liquor and saliva. The objects was to get a landmark in expectation from anion concentrations. Bromide was detected as a constant part in all body fluids. The origin and importance is not clear till now. Also was found nitrate in all investigated body fluids. There seems to be a connection between diarrhea and an increase in serum levels from nitrate. We found considerable amounts of nitrate in saliva by babies and infants. The method is distinguished by little fluctuation in measurement and high specificity. Short time in analysis and simple handling will do the method for a qualified one in pediatrics.

[Simultaneous determination of inorganic anions in body fluids. A new method in pediatric laboratory diagnosis--results of a pilot study].

Helicobacter pylori als Ursache chronischer Bauchschmerzen im Kindesalter

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Belastung unserer Kinder mit Pestiziden, PCB und potentiell kristischen Anionen

Altbekannte Schadstoffe und neuentdeckte Toxaphene im Fettgewebe von Kindern

[Simultaneous determination of inorganic anions in body fluids. A new method in pediatric laboratory diagnosis--results of a pilot study].

Helicobacter pylori als Ursache chronischer Bauchschmerzen im Kindesalter