ارزیابی و مقایسه‌ی آثار و هزینه‌های آزمون‌های غیر تهاجمی تشخیص میکروب هلیکوباکتر پیلوری

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دستیار، گروه بیماری‌های داخلی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه بیماری‌های داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 مربی، گروه گفتاردرمانی، دانشکده‌ی علوم توان‌بخشی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 متخصص بیهوشی و مراقبت‌های ویژه، گروه بیهوشی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

5 دستیار، گروه بیماری‌های داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

6 استادیار، گروه داروسازی بالینی و خدمات دارویی، مرکز تحقیقات اقتصاد و مدیریت سلامت، دانشکده‌ی مدیریت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: هلیکوباکتر پیلوری شایع‌ترین میکروب کلونیزه کننده‌ی دستگاه گوارش است. جهت اثبات عفونت از روش‌های مختلفی نظیر سرولوژی، آزمایش آنتی‌ژنی مدفوعی و آزمایش تنفسی اوره استفاده می‌شود. هدف از این مطالعه، بررسی و مقایسه‌ی آثار و هزینه‌های آزمایش‌های تشخیصی فوق بود.روش‌ها: 94 بیمار زن و مرد بالغ که اندیکاسیون انجام اندوسکوپی داشتند، وارد مطالعه شدند. در صورتی که نتیجه‌ی حداقل دو آزمایش تشخیصی بیمار (بافت شناسی، آزمایش سریع اوره‌آز، آزمایش آنتی‌ژن مدفوعی یا آزمایش تنفسی اوره) مثبت بود، وی از نظر عفونت با هلیکوباکتر پیلوری مثبت در نظر گرفته شد.یافته‌ها: دقت آزمایش آنتی‌ژن مدفوعی 91 درصد، آزمایش تنفسی اوره 82 درصد و سرولوژی 52 درصد بود.نتیجه‌گیری: به دلیل هزینه‌ی کمتر و دقت بالاتر، آزمایش آنتی‌ژن مدفوعی آزمایش ارجح در تشخیص عفونت با میکروب هلیکوباکتر پیلوری، قبل از درمان می‌باشد.

کلیدواژه‌ها

عنوان مقاله [English]

Comparative Study on Cost and Effects of Non Invasive Helicobacter Pylori Diagnostic Tests

نویسندگان [English]

  • Shadi Kazemi 1
  • Hamed Daghaghzade 2
  • Yalda Kazemi 3
  • Mohammadreza Habibzadeh 4
  • Firoozeh Moinzadeh 5
  • Majid Davari 6
  • Hamid Tavakkoli 2
  • Mohammad Hassan Emami 2
1 Resident, Department of Internal Medicine, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan,
2 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Speech Therapist, Department of Speech Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
4 Anesthesiologist, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
5 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
6 Assistant Professor, Department of Clinical Pharmacy and Pharmacy Practice, Health Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Helicobacter pylori is the most common microorganism which colonizes in gastrointestinal system. There are different methods for diagnosis of infection such as rapid stool antigen, urea breath and serology tests. The purpose of this study was comparing the cost and effectiveness of these methods.Methods: 94 dyspeptic patients with mean age of 46 ± 14 years, were evaluated. The patients were considered infected when the results of 2 tests (rapid stool antigen test, urea breath test, rapid urease test and histology) was positive.Findings: Accuracy of rapid stool antigen test was 91%, urea breath test was 82% and serology was 52%.  Conclusion: As the cost of stool antigen test was minimum, it is concluded that rapid stool antigen test is more cost-benefit, accurate and reliable test for diagnosis of helicobacter pylori compared with urea breath test and serology. 

کلیدواژه‌ها [English]

  • Helicobacter pylori
  • Stool antigen test
  • Urea breath test

مراجع

  1. Ahmed KS, Khan AA, Ahmed I, Tiwari SK, Habeeb A, Ahi JD, et al. Impact of household hygiene and water source on the prevalence and transmission of Helicobacter pylori: a South Indian perspective. Singapore Med J 2007; 48(6): 543-9.
  2. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev 2006; 19(3): 449-90.
  3. Falsafi T, Valizadeh N, Sepehr S, Najafi M. Application of a stool antigen test to evaluate the incidence of Helicobacter pylori infection in children and adolescents from Tehran, Iran. Clin Diagn Lab Immunol 2005; 12(9): 1094-7.
  4. Manes G, Zanetti MV, Piccirillo MM, Lombardi G, Balzano A, Pieramico O. Accuracy of a new monoclonal stool antigen test in post-eradication assessment of Helicobacter pylori infection: comparison with the polyclonal stool antigen test and urea breath test. Dig Liver Dis 2005; 37(10): 751-5.
  5. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1(8390): 1311-5.
  6. Mattar R, Marques SB, Monteiro MS, Dos Santos AF, Iriya K, Carrilho FJ. Helicobacter pylori cag pathogenicity island genes: clinical relevance for peptic ulcer disease development in Brazil. J Med Microbiol 2007; 56(Pt 1): 9-14.
  7. Hohenberger P, Gretschel S. Gastric cancer. Lancet 2003; 362(9380): 305-15.
  8. Calvet X, Sanchez-Delgado J, Montserrat A, Lario S, Ramirez-Lazaro MJ, Quesada M, et al. Accuracy of diagnostic tests for Helicobacter pylori: a reappraisal. Clin Infect Dis 2009; 48(10): 1385-91.
  9. Al-Humayed SM, Ahmed ME, Bello CS, Tayyar MA. Comparison of 4 laboratory methods for detection of Helicobacter pylori. Saudi Med J 2008; 29(4): 530-2.
  10. Kalem F, Ozdemir M, Baysal B. [Investigation of the presence of Helicobacter pylori by different methods in patients with dyspeptic complaints]. Mikrobiyol Bul 2010; 44(1): 29-34.
  11. De Korwin JD. [Advantages and limitations of diagnostic methods for H. pylori infection]. Gastroenterol Clin Biol 2003; 27(3 Pt 2): 380-90.
  12. Perri F, Quitadamo M, Ricciardi R, Piepoli A, Cotugno R, Gentile A, et al. Comparison of a monoclonal antigen stool test (Hp StAR) with the 13C-urea breath test in monitoring Helicobacter pylori eradication therapy. World J Gastroenterol 2005; 11(37): 5878-81.
  13. Peng NJ, Lai KH, Lo GH, Hsu PI. Comparison of noninvasive diagnostic tests for Helicobacter pylori infection. Med Princ Pract 2009; 18(1): 57-61.
  14. Vaira D, Gatta L, Ricci C, Miglioli M. Review article: diagnosis of Helicobacter pylori infection. Aliment Pharmacol Ther 2002; 16 Suppl 1: 16-23.
  15. Jonaitis LV, Kiudelis G, Kupcinskas L. Evaluation of a novel 14C-urea breath test "Heliprobe" in diagnosis of Helicobacter pylori infection. Medicina (Kaunas ) 2007; 43(1): 32-5.
  16. Bilardi C, Biagini R, Dulbecco P, Iiritano E, Gambaro C, Mele MR, et al. Stool antigen assay (HpSA) is less reliable than urea breath test for post-treatment diagnosis of Helicobacter pylori infection. Aliment Pharmacol Ther 2002; 16(10): 1733-8.
  17. Manes G, Balzano A, Iaquinto G, Ricci C, Piccirillo MM, Giardullo N, et al. Accuracy of the stool antigen test in the diagnosis of Helicobacter pylori infection before treatment and in patients on omeprazole therapy. Aliment Pharmacol Ther 2001; 15(1): 73-9.
  18. Konstantopoulos N, Russmann H, Tasch C, Sauerwald T, Demmelmair H, Autenrieth I, et al. Evaluation of the Helicobacter pylori stool antigen test (HpSA) for detection of Helicobacter pylori infection in children. Am J Gastroenterol 2001; 96(3): 677-83.
  19. Gisbert JP, Pajares JM. Diagnosis of Helicobacter pylori infection by stool antigen determination: a systematic review. Am J Gastroenterol 2001; 96(10): 2829-38.
  20. Parente JM, da Silva BB, Palha-Dias MP, Zaterka S, Nishimura NF, Zeitune JM. Helicobacter pylori infection in children of low and high socioeconomic status in northeastern Brazil. Am J Trop Med Hyg 2006; 75(3): 509-12.
  21. Carroll IM, Ahmed N, Beesley SM, Khan AA, Ghousunnissa S, Morain CA, et al. Microevolution between paired antral and paired antrum and corpus Helicobacter pylori isolates recovered from individual patients. J Med Microbiol 2004; 53(Pt 7): 669-77.
  22. Marques SB. Prevalence of H. pylori infection associated with clinical disorders diagnosed by upper gastrointestinal endoscopies, retrospective analysis of 1478 cases. Sao Paoulo: University of Sao Paoulo; 2009.
  23. Silva FM, Navarro-Rodriguez T, Barbuti RC, Mattar R, Hashimoto CL, Eisig JN. Helicobacter pylori reinfection in Brazilian patients with peptic ulcer disease: a 5-year follow-up. Helicobacter 2010; 15(1): 46-52.
  24. Gisbert JP, de la Morena F, Abraira V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol 2006; 101(8): 1921-30.
  25. Braden B, Lembcke B, Kuker W, Caspary WF. 13C-breath tests: current state of the art and future directions. Dig Liver Dis 2007; 39(9): 795-805.
  26. de Carvalho Costa CL, Rocha GA, Rocha AM, de Moura SB, de Figueiredo ST, Esteves AM, et al. Evaluation of [13C]urea breath test and Helicobacter pylori stool antigen test for diagnosis of H. pylori infection in children from a developing country. J Clin Microbiol 2003; 41(7): 3334-5.
  27. Dore MP, Negrini R, Tadeu V, Marras L, Maragkoudakis E, Nieddu S, et al. Novel monoclonal antibody-based Helicobacter pylori stool antigen test. Helicobacter 2004; 9(3):
  28. -32.
  29. Forne M, Dominguez J, Fernandez-Banares F, Lite J, Esteve M, Gali N, et al. Accuracy of an enzyme immunoassay for the detection of Helicobacter pylori in stool specimens in the diagnosis of infection and posttreatment check-up. Am J Gastroenterol 2000; 95(9): 2200-5.
  30. Hooton C, Keohane J, Clair J, Azam M, O'Mahony S, Crosbie O, et al. Comparison of three stool antigen assays with the 13C- urea breath test for the primary diagnosis of Helicobacter pylori infection and monitoring treatment outcome. Eur J Gastroenterol Hepatol 2006; 18(6): 595-9.
  31. Lahner E, Vaira D, Figura N, Pilozzi E, Pasquali A, Severi C, et al. Role of noninvasive tests (C-urea breath test and stool antigen test) as additional tools in diagnosis of Helicobacter pylori infection in patients with atrophic body gastritis. Helicobacter 2004; 9(5): 436-42.
  32. Blanco S, Forne M, Lacoma A, Prat C, Cuesta MA, Latorre I, et al. Comparison of stool antigen immunoassay methods for detecting Helicobacter pylori infection before and after eradication treatment. Diagn Microbiol Infect Dis 2008; 61(2): 150-5.
  33. Kato S, Ozawa K, Okuda M, Nakayama Y, Yoshimura N, Konno M, et al. Multicenter comparison of rapid lateral flow stool antigen immunoassay and stool antigen enzyme immunoassay for the diagnosis of Helicobacter pylori infection in children. Helicobacter 2004; 9(6): 669-73.
  34. Yang HR, Seo JK. Helicobacter pylori stool antigen (HpSA) tests in children before and after eradication therapy: comparison of rapid immunochromatographic assay and HpSA ELISA. Dig Dis Sci 2008; 53(8): 2053-8.
  35. Krausse R, Muller G, Doniec M. Evaluation of a rapid new stool antigen test for diagnosis of Helicobacter pylori infection in adult patients. J Clin Microbiol 2008; 46(6): 2062-5.
  36. Kuloglu Z, Kansu A, Kirsaclioglu CT, Ustundag G, Aysev D, Ensari A, et al. A rapid lateral flow stool antigen immunoassay and (14)C-urea breath test for the diagnosis and eradication of Helicobacter pylori infection in children. Diagn Microbiol Infect Dis 2008; 62(4): 351-6.
  37. Silva JM, Villares CA, Monteiro MS, Colauto C, Dos Santos AF, Mattar R. Validation of a rapid stool antigen test for diagnosis of Helicobacter pylori infection. Rev Inst Med Trop Sao Paulo 2010; 52(3): 125-8.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 154 - شماره پیاپی 154
مهر و آبان 1390
صفحه 1326-1333

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سابقه مقاله

  • تاریخ دریافت: 02 خرداد 1390
  • تاریخ بازنگری: 31 فروردین 1403
  • تاریخ پذیرش: 17 فروردین 1401

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