H Pylori—Are They Gone Yet?

Helicobacter pylori infection can be treated with proton pump inhibitors (PPIs) and antibiotics, but physicians need ways to determine if the bacteria are completely eradicated months later. In the May issue of Clinical Gastroenterology and Hepatology, Luigi Gatta et al. describe a simple blood test that can detect H pylori infection 2 months after treatment.

Gatta et al. used an antibody assay to detect serum markers of H pylori infection—pepsinogen I (sPGI), serum pepsinogen II (sPGII) and gastrin-17 (sG17)—in 228 patients, before and 8 weeks after eradication therapy.  The patients also underwent breath tests and biopsy analyses. The authors found that a decrease in serum level of sPGII by 22.7% or greater indicated the absence of the bacteria.

These findings are important because infection with H pylori can cause inflammation, peptic ulcers and gastric cancer. The bacteria change gastric physiology to increase serum levels of pepsinogens and secretion of gastrin. Gatta et al. speculate that levels of sPGII increase more than those of sPGI in H pylori–infected patients, and are therefore better correlated with the severity of H pylori-induced inflammation of the antrum and corpus. They also noted that H pylori–associated gastritis occurs mainly in the antrum, which could affect levels of sPGII more than sPGI.

Previous studies have investigated whether serum levels of pepsinogen or gastrin could be used to identify patients with H pylori infection after treatment, but results have been unequivocal. In an accompanying editorial, Taraq Attumi and David Graham state that this is a reliable method for testing that any clinical laboratory could provide.

Attumi and Graham add that it will be important to determine if this test is affected by co-therapy with anti-secretory drugs (especially PPIs—see below figure), smoking, or geographic differences in patients or their severity of gastritis.

The effect of PPIs on bacterial density. Percentage values indicate the reduction in H pylori density associated with PPI therapy, in different parts of the stomach.

Gatta et al. used a commercially available ELISA kit to measure these markers, but results could vary if different assays are used.

More Information on H Pylori infection:

Read the article online.
Gatta L, Di Mario F, Vaira D, et al. Quantification of serum levels of pepsinogens and gastrin to assess eradication of Helicobacter pylori. Clin Gastroenterol and Hepatol 2011;9:440–342.

Read the accompanying editorial.
Attumi TA, Graham DY. Follow-up testing after treatment of Helicobacter pylori infections: cautions, caveats, and recommendations. Clin Gastroenterol and Hepatol 2011;9:373–375.

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