1st Studium Generale International-Faculty of Medicine UI: “The Good Strategy for The Detection of Helicobacter Pylori Infection”
Dadang Makmun, SpPD-KGEH, FACG, Internist and Consultant of Gastroentero-Hepatology University of Indonesia
Dr. dr. H. Ari Fahrial Syam, SpPD-KGEH, MMB, FINASIM, FACP, Internist Gastroentrologist University of Indonesia
Prof. Yoshiro Yamaoka MD, PHD, Professor of Department of Medicine; Gastroenterology Section, in Baylor College of Medicine (Houston, Texas USA
Timor Leste (Dili DLC)
The 1st studium generale international was held by Faculty of Medicine, Universitas Indonesia via video conference at Jakarta Distance Learning Center (JDLC) UI on August 14, 2014 from 09:00-11.00 am.
The session was two hours interactive session using video conference technology that consists of presentations from Indonesia and Q&A. It discussed about “The Good Strategy for The Detection of Helicobacter Pylori Infection”.
Helicobacter pylori infection is the most common infection of human stomach caused by Helicobacter pylori bacteria. The prevalece of H pylori infection varies between countries and also within countries. Our national muticentres study ten years ago found that from 550 cases, H pylori was found positive in 56 (10.2%). The highest prevalence of H pylori was found in patients from Yogyakarta (30.6%) and the lowest was in patients from Jakarta (8%). The last survey this year found that H pylori tend to decrease up to below 5 % in Jakarta based on histopathology evaluation.
Actually, this infection is still needed to be wary. Helicobacter pylori is clinically important because it is well known to be strong correlated with peptic ulcer and gastric malignancy. Helicobacter pylori was classified as class 1 carcinogen for gastric cancer. Patients who infected with Helicobacter pylori infection should be eradicated even in the absence of ulcer disease after investigation. Based on some studies it is believed that the eradication of Helicobacter pylori can be a long term benefit in terms of reducing for peptic ulcer and gastric cancer in the future.
Symptoms of Helicobacter pylori infection are from asymptomatic, dyspepsia, abdominal pain to gastrointestinal bleeding due to complications from infections such as peptic ulcer or gastric malignancy.
Helicobacter Pylori infection can be diagnosed by invasive and non-invasive examination. Invasive tests includes histopathology, rapid urease test or culture. Non-invasive examination include the serology, the urea breath test (UBT), the urine test and the helicobacter pylori stool antigen (stool test).The American Gastroenterological Association recommends both UBT and stool test for the diagnosis of H. pylori infection in patients with dyspepsia. To follow up eradication, the UBT or stool test are both recommended as non-invasive tests for determining the success of eradication treatment. There is no role for serology for follow up eradication.Our study several years ago show that HpSA stool test, using modification cut-off value, may be useful for the primary diagnosis of H pylori infection. Its specificity is similar to other standard tests but its sensitivity is lower.
There are two strategies in the management of Helicobacter pylori infection: the test and treat strategy and endoscope and treat strategy. The test and treat strategy is appropriate in situations where the risk of gastric cancer is low. Non-Invasive testings such as UBT and stool test are preferred to Helicobacter test and treat approach. In situations that patients having Helicobacter pylori infection is low, the test and treat method is also less sensitive. In areas with a high incidence of gastric cancer and patients with dyspepsia alarm signal, the strategy of endoscope is preferred. When the endoscopy is performed, biopsy-based test such rapid urease test and histology can be carried out. If it is possible, culture from the biopsy sample can be done. The benefit of culture is due to the possibility to perform antimicrobial susceptibility test. The biopsy can be taken from antrum or corpus alone or both. Studies on biopsy sites for the diagnosis of Helicobacter pylori infection are sometimes conflicting.
Endoscopic examination itself is a standard used to evaluate the upper gastrointestinal tract . It is essential in the classification of the dyspepsia patients as organic or functional dyspepsia. Ideally, endoscopy should be carried out during asymptomatic phase of the disease. In patients with alarm signs, endoscopy can identify the cause of dyspepsia. In patients with no endoscopic abnormalities result, the negative results of this examination will reduce patient anxiety and the patient will be more comfortable .
Once the presentation is complete, the session continued with question and answer to both of speakers. Learning objetives for this session is that participants would be able to explore the pathogenesis, epidemiology, and diseases associated with H. pylori, know about high H. pylori genotypes in Asia, novel H. pylori in Okinawa, Japan, and collaborative studies in Asia and understanding the geographic differences in gastric cancer might be explained by differences among H. pylori strains that will inform the human migration patterns.