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Eficacia de la determinación fecal de Helicobacter pylori mediante la técnica HpSA en enfermos con hemorragia digestiva alta
Efficacy of the fecal determination of helicobacter pylori by the hpsa test in patients with upper gastrointestinal hemorrhage
J. Muñoz Molineroa, F. Rodríguez Lópeza, F. López Rubiob
a Servicios de Microbiología Hospital Universitario Reina Sofía. Córdoba
b Anatomía Patológica. Hospital Universitario Reina Sofía. Córdoba
D. López Peñas*, A. Naranjo Rodríguez, C. Gálvez Calderón, M. Chicano Gallardo, G. Miño Fugarolas
Unidad Clínica de Aparato Digestivo Hospital Universitario Reina Sofía. Córdoba
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        "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La prueba r&#225;pida de ureasa &#40;TRU&#41; es la m&#225;s difundida en el diagn&#243;stico de infecci&#243;n por <span class="elsevierStyleItalic">Helicobacter pylori</span> en enfermos con hemorragia digestiva alta &#40;HDA&#41;&#44; pero algunos estudios sugieren que con frecuencia es negativo falso en presencia de sangre&#46; Recientemente ha surgido una t&#233;cnica que determina ant&#237;genos de <span class="elsevierStyleItalic">Helicobacter pylori</span> en heces mediante enzima de inmunoan&#225;lisis &#40;HpSA&#41; eficaz en el diagn&#243;stico de infecci&#243;n &#40;HpSA&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudiar la validez de la t&#233;cnica HpSA en la hemorragia digestiva alta&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 32 pacientes con hemorragia digestiva alta estudiados prospectivamente desde noviembre de 1998 a abril de 1999&#46; En las 72 h siguientes al inicio del sangrado y las 24 h posteriores al ingreso se realiz&#243; a todos endoscopia digestiva alta con toma de biopsias para TRU y estudio histol&#243;gico&#44; se recogieron muestras de sangre para serolog&#237;a y de heces para HpSA y se realiz&#243; la prueba del aliento con urea marcada con 13C &#40;TAU&#41;&#46; Se defini&#243; la existencia de infecci&#243;n por la positividad de al menos dos de cuatro t&#233;cnicas diagn&#243;sticas&#44; exceptuando la t&#233;cnica HpSA&#46; Se calcularon sensibilidad&#44; especificidad&#44; valor predictivo positivo y valor predictivo negativo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El 71&#44;8&#37; &#40;23&#47;32&#41; tuvieron infecci&#243;n&#46; Cuatro HpSA &#40;12&#44;5&#37;&#41; resultaron negativos y 28 positivos &#40;87&#44;5&#37;&#41;&#46; El HpSA puso de manifiesto alta sensibilidad &#40;95&#44;6&#37;&#41; pero baja especificidad &#40;33&#44;3&#37;&#41;&#46; El valor predictivo positivo y el valor predictivo negativo resultaron del 78&#44;5 y el 75&#37;&#44; respectivamente&#46; De los 32 HpSA&#44; 25 &#40;78&#44;1&#37;&#41; se realizaron en heces mel&#233;nicas&#58; 22 fueron positivos y tres negativos&#46; El 78&#44;5&#37; de HpSA positivos y el 75&#37; de los negativos correspondieron a heces mel&#233;nicas&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El HpSA es una t&#233;cnica r&#225;pida&#44; no invasiva&#44; que no parece verse influida por la presencia de sangre por lo que es aplicable en hemorragia digestivo alta&#46; El TRU evidenci&#243; altas sensibilidad&#44; especificidad y valor predictivo positivo&#44; por lo que debe seguir como m&#233;todo de primera elecci&#243;n en la hemorragia digestiva alta&#46; El HpSA puede introducirse como segunda t&#233;cnica&#44; y es &#250;til en los casos con TRU negativo y alta sospecha de infecci&#243;n&#44; cuando no se hayan tomado muestras para TRU y cuando no se pueda efectuar la endoscopia&#46; Los resultados obtenidos en este estudio deber&#225;n confirmarse en futuros trabajos de mayor tama&#241;o muestral&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The rapid urease test is the most commonly used test in the diagnosis of <span class="elsevierStyleItalic">Helicobacter pylori</span> infection in patients with upper gastrointestinal hemorrhage&#46; However&#44; some studies have suggested that results of this test are frequently false negative when blood is present&#46; An effective new enzyme immunoassay for determining <span class="elsevierStyleItalic">H&#46; pylori</span> antigens in stools has recently begun to be used&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the efficacy of the H&#46; pylori stool antigen test &#40;HpSAT&#41; in patients with upper gastrointestinal hemorrhage&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Thirty-two patients with upper gastrointestinal hemorrhage were prospectively studied from November 1998 to April 1999&#46; In all patients the following tests were performed in the first 72 hours after onset of bleeding and 24 hours after hospital admission&#58; upper gastrointestinal endoscopy&#44; biopsy samples for the rapid urease test and histological study&#44; blood samples for serology&#44; stool samples for HpSAT&#44; and the <span class="elsevierStyleSup">13</span>C urea breath test&#46; Criteria for infection was a positive result in at least two of the four diagnostic techniques&#44; except in the case of HpSAT&#46; Sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41; and negative predictive value &#40;NPV&#41; were calculated&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Of the 32 patients&#44; 23 &#40;71&#46;8&#37;&#41; were infected&#46; The results of four HpSAT &#40;12&#46;5&#37;&#41; were negative and 28 were positive &#40;87&#46;5&#37;&#41;&#46; HpSAT showed high sensitivity &#40;95&#46;6&#37;&#41;but low specificity &#40;33&#46;3&#37;&#41;&#46; The PPV and NPV were 78&#46;5&#37; and 75&#37; respectively&#46; Of the 32 HpSAT&#44; 25 &#40;78&#46;1&#41; were performed in melenic stools&#58; 22 were positive and 3 were negative&#46; Seventy-five percent of negative HpSAT and 78&#46;5&#37; of positive HpSAT corresponded to melenic stools&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HpSAT is a rapid&#44; non-invasive technique that does not appear to be influenced by the presence of blood&#46; Consequently&#44; it can be applied in patients with upper gastrointestinal hemorhage&#46; The rapid urease test showed high sensitivity&#44; specificity and PPV and should remain the first-line test in patients with upper gastrointestinal hemorrhage&#46; HpSAT is appropriate as a second-line technique and is useful when the rapid urease test is negative and infection is strongly suspected&#44; when no samples for the rapid urease test have been taken and when endoscopy cannot be performed&#46; The result obtained in the present study should be confirmed in future studies with larger samples&#46;</p>"
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ISSN: 02105705
Idioma original: Español
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