The Helicobacter pylori breath test: a surrogate marker for peptic ulcer disease in dyspeptic patients.
BACKGROUND
There is interest in noninvasive H pylori testing as a means of predicting diagnosis and determining management in dyspeptic patients.


OBJECTIVE
To assess the value of the 14C urea breath test as a predictor of peptic ulcer disease in patients presenting with dyspepsia.


METHODS
327 consecutive patients referred for investigation of dyspepsia had a 14C urea breath test performed before endoscopy. Patients were not included if they had previously confirmed ulcer disease, previous gastric surgery, or were taking non-steroidal anti-inflammatory drugs.


RESULTS
Of the 182 patients with a positive 14C urea breath test, duodenal and/or gastric ulcers were present in 45% and erosive duodenitis in a further 2%. Oesophagitis was present in 12% of the breath test positive patients with two thirds of the oesophagitis patients having co-existent ulcer disease. The prevalence of ulcer disease in the H pylori positive dyspeptic patients was independently related to smoking and previous investigation status. If previously uninvestigated, the prevalence of ulcers was 67% in smokers and 46% in non-smokers. If previous upper gastrointestinal investigations were negative, the prevalence of ulcers was 53% in smokers and 28% in non-smokers. Of the 136 patients with a negative breath test, only 5% had peptic ulcers. The most frequent endoscopic finding in these H pylori negative subjects was oesophagitis, being present in 17%.


CONCLUSIONS
This study demonstrates that a positive H pylori test is a powerful predictor of the presence of underlying ulcer disease in dyspeptic patients, especially if smokers, and that a negative H pylori test is a powerful predictor of the absence of ulcer disease. It also indicates that a negative upper gastrointestinal investigation does not preclude subsequent presentation with ulcer disease.
McColl
K E
KE
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow.
el-Nujumi
A
A
Murray
L
L
el-Omar
E
E
Gillen
D
D
Dickson
A
A
Kelman
A
A
Hilditch
T E
TE
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D002250:Carbon Radioisotopes; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000382:microbiology; D004415:Dyspepsia / Q000382:microbiology*; D004941:Esophagitis / Q000175:diagnosis / Q000382:microbiology; D004945:Esophagoscopy; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis* / Q000382:microbiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects; D013276:Stomach Ulcer / Q000175:diagnosis / Q000382:microbiology; D014508:Urea / Q000032:analysis
D015415:Biomarkers; D002250:Carbon Radioisotopes; D014508:Urea