RESUMO
The Helicobacter pylori stool antigen enzyme immunoassay (HpSA) was evaluated during posttreatment follow-up of patients in a country with a very high prevalence of H. pylori infection. From among 273 dyspeptic individuals (18 to 55 years) initially recruited from a shantytown in Lima, Peru, 238 participants who met the inclusion criteria and were suspected to be H. pylori positive based on (14)C urea breath test (UBT) results underwent endoscopy. Participants with endoscopy-proven infections received standard eradication therapy and were monitored by UBT and HpSA at 1 month following treatment and at 3-month intervals for 9 months posttreatment. A second endoscopy was performed if UBT results showed evidence of treatment failure or H. pylori recurrence. Biopsy results were considered the "gold standard" in all analyses. Among patients who underwent endoscopy, HpSA had a pretreatment sensitivity of 93%. Two-hundred thirty patients completed the treatment regimen, of whom 201 (93%) were considered to have had successful treatment outcomes based on a negative follow-up UBT. Thirty-two patients with UBT-defined treatment failures or H. pylori recurrences at any point during the 9-month follow-up underwent a second endoscopy. In the posttreatment setting, HpSA had an overall sensitivity of 73% and a specificity of 67%. Agreement between UBT and HpSA diminished throughout the follow-up. Among 14 participants in whom HpSA remained positive at 1 month following treatment despite UBT evidence of treatment success, 12 (86%) became HpSA negative within 3 months posttreatment. Although this study confirmed the validity of the HpSA in the initial assessment of dyspeptic patients, the test demonstrated a reduced overall accuracy in the detection of treatment failures and H. pylori recurrences during 9 months of posttreatment follow-up. Furthermore, in some patients it may take up to 3 months after successful eradication for antigen shedding to diminish to levels within the negative HpSA range.
Assuntos
Antígenos de Bactérias/análise , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Adolescente , Adulto , Antígenos de Bactérias/imunologia , Fezes/microbiologia , Seguimentos , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/imunologia , Helicobacter pylori/imunologia , Humanos , Imunoensaio/métodos , Pessoa de Meia-Idade , Peru/epidemiologiaRESUMO
Thirty two patients (18 males whose ages ranged from 32 to 68 years old) with hepatitis C virus chronic hepatitis (positive anti-HCV by ELISA, conformed by RIBA II) that were followed by the authors during 2 to 25 years, were retrospectively analyzed. 13 subjects had a history of blood transfusions, one had an accidental pinprick and other sexual contact with a HCV positive individual; the transmission source was not identified in the resting 19 subjects. Only 5 individuals had an acute onset. The rest of the patients had a few symptoms with moderate and fluctuating transaminase elevations. Liver biopsy at the onset showed a chronic hepatitis with moderate activity, even in 15 individuals with cirrhosis (47 percent). During follow up, six subjects deteriorated clinically, appearing liver failure and 3 of these died 4, 5 and 14 years after the disease appearance. No subject developed a hepatocarcinoma