Attiya Tareen, Tariq Butt, Bazla Ali.
Helicobacter pylori infection in patients with chronic urticaria and dyspepsia, experience from a developing country.
J Pak Assoc Derma Jan ;26(3):206-13.

Objective: To determine Helicobacter pylori infection using stool antigen assays and H pylori IgM antibodies in patients having chronic urticaria and dyspepsia. Methods: This descriptive, cross-sectional study was conducted at Department of Dermatology and Department of Pathology, Fauji Foundation Hospital, Rawalpindi from May 2014 to April 2015. By non-probability purposive sampling technique, 87 patients diagnosed as having chronic urticaria and each patient having symptoms of gastritis were tested for H pylori infection using the monoclonal H pylori fecal antigen assay (Biotec®, Spain) and serological test for presence of IgM antibodies (acute infection). Patients infected with HP were given triple regimen comprising of omeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily for 10 days. HP eradication was assessed by monoclonal fecal antigen assay after 4 weeks. Beneficial effect was determined by subjective response to treatment and improvement in urticarial symptoms by using chronic urticaria quality-of-life questionnaire (CU-Q2oL) while objective response to treatment was judged by need for antihistamine medication post eradication. Results: Stool antigen was positive for H pylori in 52 (59.8 %) and IgM antibodies were present in 63 (72.4%) of patients with chronic urticaria and dyspepsia. After antibacterial therapy, there were 40 of 52 stool samples became negative, among them the remission of urticaria and dyspepsia was observed in 39 (75%). There were 50/63 (79.4%) H pylori IgM positive patients who responded to triple regimen therapy, when eradication was considered by objective improvement in urticaria and gastritis symptoms. However, when stool antigen along with serum IgM were considered simultaneously, there was 80% (52/65) remission response after the treatment (P = 0.0001). CUQ2oL for patients who received specific treatment revealed significant improvement (P = 0.0001) while patients without specific treatment revealed no change (P=0.1). Conclusion: Urticaria and dyspepsia are associated with H. pylori infection and presence of this organism in such cases can be detected with confidence by using non invasive, sensitive, specific and cheaper techniques like stool H. pylori antigen and serum H. pylori IgM antibodies. This is particularly true in developing counties like ours where because of financial constraints, invasive techniques like gastric antral biopsy, biopsy urease test and costly noninvasive urea breath test are difficult to perform. The response of HP eradication therapy in infected patients of CU is significant and HP detection should be included in the diagnostic work up of all patients with CU and dyspepsia. However, due to intermittent shedding of the microorganism in feces, HpSA declared negative, before eradication treatment in patients with strong suspicion of H pylori should be repeated again to be certain of the diagnosis.

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