Seite 8 - Medizin_Report

8

ration of stool samples is a lot less

acceptable to patients. In addition,

stool samples need to be transport-

ed and stored frozen and analysed

within 24 hours – conditions which

cannot always be guaranteed. More-

over, the sensitivity and specificity

depends on and varies with the qual-

ity of the detecting antibody.

Which invasive tests are mainly

used these days?

Strowski:

Normally, the rapid Ure-

ase Test combined with histopatho-

logical detection of Helicobacter

pylori is performed during endosco-

py. This test has the disadvantage

of not only being invasive but is also

expensive. Endoscopy of the upper

gastrointestinal tract is carried out

on sedated patients and takes a long

time, especially when taking into ac-

count the time needed for monitor-

ing the patient until they have fully

recovered from the examination.

Endoscopy out-patients who have

been sedated must be accompanied

by another person on their journey

home. They are not allowed to drive.

Cave: liability aspects must be con-

sidered here. It is not sufficient to

simply inform the patient of this but

to check that they adhere to the

guidelines.

Which non-endoscopic methods

are there?

Strowski:

Another method is the

measurement of Helicobacter pylori

antibodies in the blood. However,

this test can still deliver positive re-

sults weeks after successful treat-

ment of the infection. It is therefore

not suitable for monitoring after

eradication. It is also complicated to

perform as the samples need to be

transported and stored properly.

How do you treat a patient with

a positive Helicobacter pylori di-

agnosis?

Strowski:

Treatment is with PPI and

two different antibiotics. Amoxicillin,

Clarithromycin and Metronidazole

are mainly used. The choice of anti-

biotics is also influenced by factors

such as allergies, documented drug

intolerance and ethnic background.

What happens in cases of infec-

tion with resistant Helicobacter

pylori?

Strowski:

As much as 85% of pa-

tients with a Helicobacter pylori in-

fection respond to treatment with

first line antibiotics and PPI. If the

patient doesn’t respond, treatment

with a second line antibiotic is con-

sidered. A resistance test can be car-

ried out during the endoscopy proce-

dure. In cases where both first and

second line treatment fails, I recom-

mend undergoing an endoscopy to

enable a resistance test to be per-

formed.

Professor Strowski, many thanks for

this interview!

Interviewers:

Dr. Ralph Hausmann

and Uwe Grunwald

What has your clinical experience

been with the test?

Strowski:

We have introduced the

Diabact

®

Urea Breath Test in our

clinic because it’s quicker to perform

and more pleasant for the patient

than traditional tests. Both test and

waiting times are reduced since our

staff no longer needs to dissolve the

13

C Urea in orange juice. We can also

rule out costly failed test attempts.

More patients can be tested due to

time savings.

So does this also imply that the

test procedures are simplified?

Strowski:

Most definitely! Some

basic practical problems and issues

become irrelevant when we use the

ready-made tablet - questions such

as where to store the orange juice?

Certainly not in the drugs cupboard!

In the staff refrigerator, possibly?

Should we invest in new equipment

to store fruit juice?

And then – who is responsible for

supplying the juice? Who monitors

the expiry date of opened cartons?

This may sound banal but it’s often

this sort of minor detail that impairs

our productivity.

Do you use Diabact

®

Test for both

primary and follow-up diagnosis?

Strowski:

Evaluation of the test in

both diagnostic scenarios delivered

very reliable results. We employ the

test on both previously untreated pa-

tients and also for monitoring after

eradication of Helicobacter pylori in-

fections.

Howwell do patients tolerate the

test?

Strowski:

Patients with experience

of the traditional test were extreme-

ly pleased with the advantages and

short test time.

What other non-invasive tests are

there for Helicobacter pylori?

Strowski:

An alternative non-inva-

sive assay is the antigen stool test

which tests for Helicobacter pylori

antigens. The collection and prepa-

Interview: The Diagnosis of Helicobacter pylori – what is the current status?

Imprint

Editors

Dr. med. Ralph Hausmann,

Uwe Grunwald (editor in chief)

Composing and illustrations by Claudia Manhardt

Printed and bound in Germany

by (Publisher) Verlag ME - Uwe Grunwald

Am Himberger See 54

53604 Bad Honnef, Germany

+49 (0)2224 / 9884256

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publisher of this work has been asserted by him

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Patents Act 1988. This work is subject to copy-

tion may be reproduced, stored in a retrieval sys-

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Notice (Disclaimer)

Medical knowledge is constantly changing. Stand-

ard safety precautions must be followed, but as

new research and clinical experience broaden our

knowledge, changes in treatment and drug therapy

may become necessary or appropriate. Readers are

advised to check the most current product informa-

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