SLIDE Viêm dạ dày, nhiễm vi khuẩn Helicobacter pylori

NHÂN MỘT TRƯỜNG HỢP Viêm dày, nhiễm vi khuẩn Helicobacter pylori Bs Lê Đình Tín Phịng Khám Tiêu Hóa – Gan Mật Bàn luận Ngày 18/10/2012 Triệu chứng - Buồn nơn, nóng ruột, quặn bụng Xét nghiệm HP test IgG IgM: NEG - Đau thượng vị âm ỉ 24/8/2017 - Đã điều trị HP Bv ĐHYD, muốn kiểm tra Nhận định Không nhiễm HP Không nhiễm HP, khả năng: HP breath test: NEG -Nhiễm HP điều trị hết -Âm tính giả Nhiễm HP, khả năng: 24/12/2018 - Đau hơng phải, khó chịu vùng thượng vị HP breath test: POS -Tái phát hay Tái nhiễm -Dương tính giả (ít) False-negative results …There is firm evidence to implicate that recent use of proton pump inhibitors (PPI) (within weeks) or antimicrobials (within weeks) may lead to a decrease in the gastric bacterial load causing falsenegative results Bleeding can also reduce the sensitivity of both UBT and SAT Data from a systematic review suggests repeating diagnostic tests in patients with bleeding ulcer after at least weeks in case of a negative result In patients with precancerous conditions (e.g atrophic gastritis, intestinal metaplasia) or gastric cancer, as well as in patients with partial gastrectomy, diagnostic tests may have lower accuracy False-positive results …Apart from false-negative results listed above, UBT also gives false-positive results, which have received more attention during the past 10 years These false-positive results are typical to patients with acid-free stomach (due to AG or a long term use of PPIs), where urease-positive bacterial species or yeast-like organisms colonize http://www.mathewsopenaccess.com/PDF/Gastroenterology/M_J_Gast_1_1_007.pdf Bàn luận Successful eradication of H pylori is defined as negative H pylori status in a previously H pylori‐infected patient at least weeks after treatment Recurrence is defined as evidence of an active H pylori infection in a patient with previously confirmed H pylori eradication Recurrence can occur either by recrudescence or reinfection -Recrudescence is defined as reappearance of the original infection that was temporarily suppressed leading to false results tests regarding eradication -Reinfection is defined as infection with a new strain of H pylori or recurrence of infection after an as yet undefined period (eg, months to years) https://onlinelibrary.wiley.com/doi/full/10.1111/apt.14319#apt14319-bib-0015 Recrudescence reflects the reappearance of the originnal strain of H pylori following its temporary suppression rather than successful eradication Instead, true reinfection occurs when, after successful eradication, a patient becomes infected with either the original strain or a new strain of H pylori http://mattioli1885journals.com/index.php/actabiomedica/article/view/7947/7707 …Recurrence of H pylori after eradication is rare in developed countries and more frequent in developing countries The proportion of H pylori annual recurrence was 2.67% and 13.00% in developed and developing countries, respectively …A different approach for follow-up after H pylori eradication is probably needed in patients of developing countries, since reinfection is highly prevalent https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693738/ Aim: To evaluate the global recurrence rate following H pylori eradication therapy and confirm its association with socioeconomic and sanitary conditions Methods: A systematic search of PubMed, EMBASE and the Cochrane library was performed to identify potentially relevant publications using the following keywords: “Helicobacter pylori” or “H pylori” or “Hp” and “recurrence” or “recrudescence” or “reinfection” or “recurrent” or “recurred” or “re‐infect*” or “relapse*.” Results: A total of 132 studies (53 934 patient ‐years) were analysed -The global annual recurrence, reinfection and recrudescence rate of H pylori were 4.3% (95% CI, 4‐5), 3.1% (95% CI, 2‐5) and 2.2% (95% CI, ‐3), respectively -The H pylori recurrence rate was inversely related to the human development index (HDI) (ie, 3.1% [95% CI, 2‐4], 6.2% [95% CI, 4‐8] and 10.9% [95% CI, ‐18] in countries with a very high, high and medium or low HDI) (P