Usefulness of 13C-Urea Breath Test in the Diagnosis of Gastric Helicobacter Pylori Infection

Helicobacter pylori chronically infects half of the human population and is associated with gastritis, peptic ulcer and gastric cancer. C-13-urea breath test (UBT) is the main in vivo tool for the diagnosis of H. pylori infection. In this study, the safety and the accuracy of UBT were evaluated.A group of 492 dyspeptic patients was studied by UBT, the results were expressed as the difference over baseline at 30 min (DOB30). All patients were evaluated for systemic, gastrointestinal or allergic-type adverse reactions after ingestion of 75 mg C-13-urea and citric acid in aqueous solution, The first 256 patients enrolled also underwent endoscopy and gastric biopsy. Patients positive on histology were considered infected.UBT was well tolerated and none of the 492 patients had any systemic or allergic-type adverse reaction. Among the 256 patients studied with histology, 116 were H. pylori positive on biopsies. Using 4 %o as cut-off value for DOB30, 115 out of the 256 patients were positive on UBT, with only 2 false positive and 3 false negative, With this threshold, the sensitivity, specificity, and accuracy of the UBT were 97.4 %, 98.5 %, and 98.0 %, respectively.C-13-UBT has proven to be a safe and simple, yet accurate, test for the non-invasive diagnosis and monitoring of H. pylori infection

Intragastric acidification reduces the occurrence of false-negative urea breath test results in patients taking a proton pump inhibitor

The aim of this study was to investigate whether reducing intragastric pH, at the time of urea ingestion, decreases the likelihood of false-negative (FN) urea breath test (UBT) results in patients taking a proton pump inhibitor (PPI). Methods : Patients with active Helicobacter pylori infection underwent a baseline 14 C-UBT (UBT-1) followed by treatment with lansoprazole 30 mg/day for 14 to 16 days. On day 13, patients returned for a repeat standard UBT (UBT-2). Between days 14 to 16, patients underwent a modified UBT (UBT-3), which included consuming 200 ml of 0.1 N citrate solution 30 min before and at the time of 14 C-urea administration. Breath samples were collected 10 and 15 min after 14 C-urea ingestion. Mean 14 CO 2 excretion and the number of FN and equivocal UBT results were compared for the three UBTs. Results : A total of 20 patients completed the study. Lansoprazole caused a significant decrease in mean breath 14 CO 2 excretion (disintegrations per minute) between UBT-1 (2.96 ± 0.23) and UBT-2 (2.08 ± 0.52, p < 0.05 ). Lansoprazole caused six (30%) FN and eight (40%) equivocal UBT-2 results. Mean breath 14 CO 2 excretion for UBT-3 (677 ± 514) was greater than for UBT-2 (234 ± 327, p = 0.001 ). UBT-3 caused only two (10%) FN and three (15%) equivocal results. The 15-min breath sample caused fewer FN and equivocal results than the 10-min sample for both UBT-2 and UBT-3. Conclusions : Giving citrate before and at the time of 14 C-urea administration increases mean breath 14 CO 2 excretion and decreases FN and equivocal UBT results in patients taking a PPI. These observations suggest that it may be possible to design a UBT protocol that will remain accurate in the face of PPI therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71971/1/j.1572-0241.2001.03687.x.pd