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2007, vol. 135, br. 1-2, str. 26-30
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Upoređivanje tri dijagnostička metoda za potvrdu infekcije izazvane Helicobacter pylori
Comparison of three diagnostic methods to confirm Helicobacter pylori infection
aUniverzitet u Beogradu, Medicinski fakultet, Institut za mikrobiologiju i imunologiju bKlinički centar Srbije, Klinika za gastroenterohepatologiju, Beograd
e-adresa: natasa.opavski@yahoo.com
Sažetak
Uvod: Helicobacter pylori dovodi do zapaljenja sluznice želuca, što povećava rizik za nastanak ulcerozne bolesti želuca i duodenuma, kao i adenokarcinoma. Budući da je ulcerozna bolest jedan od vodećih uzroka morbiditeta ljudi, vrlo je važno postaviti ispravnu dijagnozu infekcije koju je izazvao H. pylori. Nažalost, među postojećim dijagnostičkim testovima nema nijednog koji bi zadovoljio kriterijume zlatnog standarda. Kada se obavlja gastroskopija, najčešće se koriste histopatologija i brzi ureaza-test. Ipak, kultivisanje ov e bakterije je važno radi ispitivanja osetljivosti na antibiotske lekove i istraživanje faktora virulencije. Cilj rada Cilj ov e studije je bio da se uporede tri dijagnostička postupka koja se koriste za potvrdu infekcije izazva ne H. pylori - histopatologija, brzi ureaza- test i kultura. Metod rada Od 28 bolesnika sa dispepsijskim tegobama kojima je rađena endoskopija uzeta su tri para bioptata želuca. Devetnaest bolesnika nije prethodno lečeno od infekcije s H. pylori, dok je devetoro primalo eradikacionu terapiju. Jedan par bioptata je korišćen za histopatološku analizu, drugi za brzi ureaza-test, a treći je istovremeno zasejan na neselektivnu i selektivnu podlogu. Izolat je identifikova n kao H. pylori na osnovu izgleda kolonija, morfoloških osobina i biohemijskih testova . Rezultati Na osnovu rezultata svih dijagnostičkih postupaka, kod 14 od 28 ispitanika potvrđena je infekcija s H. pylori. Podudarnost između ov ih metoda je bila vrlo dobra s obzirom na to da su se rezultati histopatologije, brzog ureaza- testa i kulture poklapali kod 26 od 28 bolesnika. Zaključak Zaključak ove studije je da se kultivisanje, s obzirom na visok stepen poklapanja s ostala dva postupka i na to da je jedini koji daje informacije o osetljivosti helikobaktera na antibiotske lekove, može preporučiti kao dodatni dijagnostički test za potvrdu infekcije izazvane H. pylori.
Abstract
Introduction: Helicobacter pylori induces gastric inflammation in host and such gastritis increases the risk of gastric and duodenal ulceration as well as adenocarcinoma. Because peptic ulcer disease is the major cause of morbidity, accurate diagnosis of H. pylori infection is very important. Unfortunately, there is no gold standard among diagnostic tests for Helicobacter infections. If gastroscopy is performed, histopathology and urease test are the most often used. Still, culturing of this bacterium is essential for drug susceptibility testing and analysis of virulence factors. Objective The aim of this study was to compare three diagnostic procedures - histopathology, urease test and culture, which are used to verify H. pylori infection. Method Three pairs of gastric mucosal biopsy specimens were collected from each of 28 dyspeptic patients undergoing endoscopy. Nineteen patients were not pretreated with antibiotics, while nine had received eradication therapy earlier. One pair of biopsy specimens was used for histopathologic examination, the second for urease test and the third was simultaneously cultured on nonselective and selective solid media. Isolate was identified as H. pylori on the basis of colony morphology, morphological properties and biochemical tests. Results In 14 out of 28 patients, H. pylori infection was confirmed on the basis of results of all diagnostic procedures. The concordance of these three methods was very good, because the results of histopathology, urease test and culture corresponded in 26 from 28 patients. Conclusion The conclusion of our study is that culture, as the method with high degree of concordance with other two procedures and the only that can give information on drug susceptibility of Helicobacter, is recommended for diagnosis of Helicobacter pylori infection along with histopathology and urease test.
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