Assessment of a novel method to detect clarithromycin-resistant Helicobacter pylori using a stool antigen test reagent
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Assessment of a novel method to detect clarithromycin‑resistant Helicobacter pylori using a stool antigen test reagent Toshihiko Kakiuchi1* , Kazutoshi Hashiguchi2, Ichiro Imamura2, Aiko Nakayama1, Ayako Takamori3, Masumi Okuda4 and Muneaki Matsuo1
Abstract Background: The resistance rate of Helicobacter pylori to clarithromycin (CAM) is high among infected children in Japan. Therefore, a new method for detecting CAM-resistant H. pylori using a minimally invasive technique is strongly desired. We aimed to investigate the clinical usefulness of our newly developed nested polymerase chain reactionquenching probe (Nested PCR-QP) method using stool specimens. Methods: We first evaluated our method using a residual solution of the H. pylori stool antigen test for adolescents. Then, we evaluated our method using culture testing for adults. Results: Among 57 middle school students with H. pylori, the Nested PCR-QP test results of 53 (90.3%) were able to be analyzed. A total of 28 students had CAM resistance mutations. We found a genetic mutation in 28 students and no mutation in 23 students, and these results were consistent with those of PCR-direct sequencing. In the 23 adults who were diagnosed with H. pylori infection using the rapid urease test and culture testing, we were able to use Nested PCR-QP for analyzing 21 adults who tested positive in the stool H. pylori antigen test. The results obtained for all 21 adults were consistent with those obtained via the drug susceptibility test. Conclusions: Our novel method could be useful for non-invasively detecting CAM resistance mutations in H. pylori. This may help select a drug to reduce eradication failure rates against H. pylori. Trial registration This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (no. UMIN000030632, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034977) on 29 December 2017. Keywords: 23S rRNA, Clarithromycin resistance, Genetic mutation, Drug susceptibility test Background Helicobacter pylori infects the gastric mucosa, where it causes chronic inflammation, which in turn increases the risk of gastric cancer [1–4]. Eradication of H. pylori reduces the risk of gastric cancer [3, 5–8]. H. pylori eradication is also more effective at reducing the risk of gastric *Correspondence: [email protected]‑u.ac.jp 1 Department of Pediatrics, Faculty of Medicine, Saga University, 5‑1‑1 Nabeshima, Saga‑shi, Saga 849‑8501, Japan Full list of author information is available at the end of the article
cancer in younger individuals than in older individuals who have suffered from chronic gastritis over a long duration [9–14]. In Japan, While the age-standardized incidence and mortality rates of gastric cancer are decreasing in men and women, gastric cancer has the highest incidence in men and the third highest incidence in women among all cancers. Furthermore, the gastric cancer mortality rate is second highest in men and third highest in women among
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