jsmc-10144

COMPARISON OF 14C-UREA BREATH TEST WITH GASTRIC HISTOLOGY FOR DIAGNOSIS OF HELICOBACTER PYLORI INFECTION AMONG PATIENTS WITH PEPTIC ULCER DISEASE   

Taha Ahmed M. Alkarboly a, Hiwa Abubakr Husein b and Heero Ismail Faraj b

a Department of Medicine, College of Medicine, University of Sulaimani. 

b Kurdistan Centre of Gastroenterology and Hepatology, Directorate of Health, Sulaimani.

 

Submitted: 15/5/2017; Accepted: 26/11/2017; Published 15/4/2018

DOI Link: https://doi.org/10.17656/jsmc.10144 

ABSTRACT

Background

Helicobacter pylori infection is common among patients with peptic ulcer disease. The definitive means of diagnosing infection being histology requires endoscopy and sedation making it invasive and expensive. The carbon urea breath test is generally considered to be a simple, non-invasive and accurate test for the detection of Helicobacter pylori infection both before and after treatment.

Objectives 

Our objective was to compare histology with a less invasive and safer method, the 14C-urea breath test.

Materials and Methods

After approval of Ethical committee of the Iraqi Board for Medical Specialties, informed consent were taken from every patient before esophagogastroduodenoscopy. Fifty patients with peptic ulcer disease diagnosed by endoscopy were evaluated by 14C-urea breath test. Four biopsies were taken for histology. After endoscopy, each patient was evaluated by both tests for diagnosis of Helicobacter pylori infection

Results

50 patients with peptic ulcer disease Helicobacter pylori infection was diagnosed in 35 patients (63.45%), while in 15 patients (36.55%) were negative for Helicobacter pylori infection using gastric histology and urea breath test. Compared with histology, the diagnostic values of the 14C-urea breath test were: sensitivity 94%, specificity 87%, positive predictive value 94%, and negative predictive value 87%. 

Conclusion

The 14C-urea breath test is a noninvasive diagnostic tool for Helicobacter pylori infection. It’s a sensitive and specific test with excellent positive predictive value and its good negative predictive value guarantee its usefulness in clinical practice.

KEYWORDS

Helicobacter pylori, Peptic ulcer disease, 14C-urea breath test.

References 

1. Marshall BJ, Warren JR, Goodwin CS. Duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet 1989; i: 846.

2. Jones DM, Lessels AM, Eldridge J. Campylobacter like organisms in the gastric mucosa: Culture, histological and serological studies. J ClinPathol 1984; 37: 1002–1006.

3 .Logan RPH, Walker MM. Epidemiology and diagnosis of Helicobacter pylori infection. Br Med J 2001; 323: 920–922.

4 .Whitaker CJ, DubielAJ.Gaplin.Social and geographical risk factors in Helicobacter pylori infection.Epidemiol Infect 1993; 111: 63.

5 .Neale KR, Logan RPH.The epidemiology and transmission of Helicobacter pylori infection in children.AlimentPharmacol 1995; 9(Suppl 2): 77–84.

6. NIH Consensus Development Panel on Helicobacter pylori in peptic ulcer disease. Helicobacter pylori in peptic ulcer disease.JAMA 1994; 272: 65–69.

7. International Agency for Research on Cancer.Schistosomes, liver flukes and Helicobacter pylori. Lyon: IARC, 1994; 61: 177–241.

8. Goodwin, CS, Worsley, BW. Microbiology of Helicobacter pylori. GastroenterolClin North Am 1993; 22:5.

9. Amieva, MR, El-Omar, EM. Host-bacterial interactions in Helicobacter pylori infection. Gastroenterology 2008; 134:306.

10. Cave, DR. Transmission and epidemiology of Helicobacter pylori. Am J Med 1996; 100(Suppl 5A):12S.

11. Pounder, RE, Ng, D. The prevalence of Helicobacter pylori infection in different countries.AlimentPharmacolTher 1995; 9(Suppl 2):33.

12. Torres, J, Leal-Herrera, Y, Perez-Perez, G, et al. A community-based seroepidemiologic study of Helicobacter pylori infection in Mexico. J Infect Dis 1998; 178:1089.

13. Hunt, RH, Sumanac, K, Huang, JQ. Should we kill or should we save Helicobacter pylori? Aliment PharmacolTher 2001; 15 Suppl 1:51. 

14. Webb, PM, Knight, T, Greaves, S, et al. Relation between infection with Helicobacter pylori and living conditions in childhood: Evidence for person to person transmission in early life. Br Med J 1994; 308:750. 

15. Kivi, M, Johansson, AL, Reilly, M, et al. Helicobacter pylori status in family members as risk factors for infection in children. Epidemiol Infect 2005; 133:645.

16. Perry, S, de la, Luz Sanchez M, Yang, S, et al. Gastroenteritis and transmission of Helicobacter pylori infection in households. Emerg Infect Dis 2006; 12:1701.

17. Megraud, F. Transmission of Helicobacter pylori: Fecal-oral versus oral-oral route. Aliment PharmacolTher 1995; 9(Suppl 2):85.

18. Leide-Svegborn, S, Stenstrom, K, Olofsson, M, et al. Biokinetics and radiation doses for carbon-14 urea in adults and children undergoing the Helicobacter pylori breath test. Eur J Nucl Med 1999; 26:573

19. Howden, CW, Hunt, RH. Guidelines for the management of Helicobacter pylori infection. Am J Gastroenterol 1998; 93:2330.

20. Gatta, L, Vakil, N, Ricci, C,et al. Effect of proton pump inhibitors and antacid therapy on C urea breath tests and stool test for Helicobacter pylori infection. Am J Gastroenterol 2004; 99:823.

21. Laine, L, Estrada, R, Trujillo, M, et al. Effect of proton-pump inhibitor therapy on diagnostic testing for Helicobacter pylori. Ann Intern Med 1998; 129:547.

22.  Chey, WD, Wong, BCY. American College of Gastroenterologoy guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007; 102:1808.

23. Gisbert, JP, Esteban, C, Jiminez, I, et al. 13C-urea breath test during hospitalization for the diagnosis of Helicobacter pylori infection in peptic ulcer bleeding. Helicobacter 2007; 12:231.

24. Malfertheiner, P, Megraud, F, O'Morain, C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56:772.

25. Kelly, SM, Pitcher, MC, Farmery, SM, et al. Isolation of Helicobacter pylori from feces of patients with dyspepsia in the United Kingdom. Gastroenterology 1994; 107:1671. 

26. Braden, B, Teuber, G, Dietrich, CF, et al. Comparison of new faecal antigen test with 13C-urea breath test for detecting Helicobacter pylori infection and monitoring eradication treatment: Prospective clinical evaluation. BMJ 2000; 320:148. 

27. Vaira, D, Malfertheiner, P, Megraud, F, et al. Diagnosis of Helicobacter pylori infection with a new non-invasive antigen-based assay. Lancet 1999; 354:30.

28. Trevisani, L, Sartori, S, Galvani, F, et al. Evaluation of a new enzyme immunoassay for detecting Helicobacter pylori in feces: A prospective pilot study. Am J Gastroenterol 1999; 94:1830.

29. Siddique I, Al-Mekhaizeem, K, Alateeqi,N,etal.Diagnosis of Helicobacter pylori :improving the sensitivity of CLO testby increasing the number of gastric antral biopsies . J Cin Gastroenterol2008 ;42:356

30. Weston, AP, Campbell , DR, Hassanein, RES, et al .Prospective multivariate evaluation of CLO test performance .Am J Gastroenterol 1997;92:1310 

31. Yousfi, MM, El-Zimaity,MTGenta,RM et al .Evaluation of a new reagent strip rapid urease test for detection of Helicobacter pylori infection .GastrointestEndosc 1996;44:519

32. Nishikawa, K, Sugiyama, T, Kato, M et al. A prospective evaluation of a new rapid urease tests before and after eradication treatment of helicobacter pylori, in comparison with histology, culture and C-urea breath test.GastrointestEndosc 2000; 51:164

33. Wright , CL,Kelly ,JK, The use of routine special stains for upper gastrointestinal biopsies .Am J SurgPathol 2006;30:357.

34. Garza-González E, Perez-Perez GI, Maldonado-Garza HJ and Bosques-Padilla FJ. (2014). A review of elicobacter pylori diagnosis, treatment, and methods to detect eradication. World J Gastroenterol. 20(6), 1438–1449.

35. Ciociola ,AA, McSorlwy,DJ,Turner,KG,et al .Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated .Am J Gastroenterol1999; 94:1834.

36.Tytgat, Langenberg, W, Rauws, E, et al.Compylobacter-like organism (CLO) in the human stomach.Gastroenterology1985; 88:1620.

37. Harris,AW,Gummett,PA,Phull,PS,et al .Recurrence of duodenal ulcer after Helicobacter pylori eradication is related to high acid output.AlimentPharmacolTher 1997;11:331.

38. McColl, KE,El-Nujumi, AM,Chitajulla,RS, et al .A study of the pathogenesis of Helicobacter pylori-negative duodenal ulceration.Gut 1993;34:762.

39. Kurata, JH. Epidemiology: peptic ulcer risk factors. SeminGastrointest Dis 1993; 4:2.

40. Lam, SK. Differences in peptic ulcer between East and West. Baillieres Best Pract Res ClinGastroenterol 2000; 14:41.

41.Goto Y, Syam AF, Darnindro N et al .Prevalence and Risk Factors for Helicobacter Pylori Infection among Healthy Inhabitants in Northern Jakarta, Indonesia.Asian Pac J Cancer Prev.2016 Oct 1; 17(10):4747-4753

42. Singh, V, Trikha, B, Nain, CK, et al. Epidemiology of Helicobacter pylori and peptic ulcer in india. J GastroenterolHepatol 2002; 17:659.

43. Wong, BC, Ching, CK, Lam, SK, et al. Differential north to south gastric cancer-duodenal ulcer gradient in China. China Ulcer Study Group. J GastroenterolHepatol 1998; 13:1050.

44. Jyotheeswaran, S, Shah, AN, Jin, HO, et al. Prevalence of Helicobacter pylori in peptic ulcer patients in greater Rochester, NY: Is empirical triple therapy justified? AM J Gasteroenterol 1998; 93:574 .

45. Nakhaei, MM. Prevalence of helicobacter pylori infection in patients with digestive complaints using urea breath test in Mashhad, Northeast Iran. JRHS. 2010; 10(2):77-80.

46. Chiorean, M, Locke, G, Zinsmeister, A, et al. Changing rates of Helicobacter pylori testing and treatment in patients with peptic ulcer disease. Am J Gastroenterol 2002; 97:3015.

47. Huang, J, Sridhar, S, and Hunt, R. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet 2002; 359:14.)

48. Rasool S, Abid S, Jafri W. Validity and cost comparison of 14carbon urea breathe test for diagnosis of H.pylori in dyspeptic patients. World J Gastroenterol. 2007; 13(6):925-929.

49. Gomollon F, Ducons JA, Santolaria S, et al. Breath test is very reliable for diagnosis of Helicobacter pylori infection in real clinical practice. Digestive and Liver Disease. 2003; 35(9):612-618.)

50.Zhou Q, Li L, Ai Y et al Diagnostic accuracy of the 14C-urea breath test in Helicobacter pylori infections: a meta-analysis.Wien KlinWochenschr. 2017 Jan; 129(1-2):38-45

51. Mion F, Delecluse HJ, Rousseau M, et al [13C-urea breath test for the diagnosis of Helicobacter pylori infection. Comparison with histology].GastroenterolClin Biol. 1994; 18(12):1106-11.

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