title: [14C]-urea breath test to confirm eradication of Helicobacter pylori.
abstract: BACKGROUND
  Treatment for Helicobacter pylori reduces ulcer recurrence. Eradication rates of the organism vary with different drug regimens from 30% to 90%. There is a need to identify patients who have failed treatment. [14C]-Urea breath test (UBT) is non-invasive, sensitive, safe and highly reliable test for diagnosis of H. pylori infection. As there is a paucity of reports on the utility of [14C]-UBT in confirming H. pylori eradication, this study was undertaken.
  
  
  METHODS
  Thirty-eight patients (age 34 +/- 17 years, range 16-84 years, 27 men) with upper gastrointestinal symptoms underwent upper gastrointestinal endoscopy. Baseline H. pylori infection was diagnosed by identification of the organism on antral biopsies and positive rapid urease test (RUT). After 1 month of completion of treatment, repeat RUT and histological examination of antral endoscopic biopsies were performed. Eradication of H. pylori was defined as absence of the organism on histology, and negative RUT. The [14C]-UBT was performed using 185 kBq [14C]-urea dissolved in 300 mL water. Breath samples were collected once before ingestion of [14C]-urea, and subsequently at 5 and 15 min. Results were expressed as 14CO2/mmol CO2 exhaled as per cent of administered urea.
  
  
  RESULTS
  Endoscopy revealed antral gastritis (n = 14), duodenal ulcer (n = 8), duodenitis (n = 2), oesophagitis (n = 1), antral gastritis and duodenal ulcer (n = 3), antral gastritis and duodenitis (n = 7) and normal upper gastrointestinal endoscopy (n = 3). All the 20 patients who were negative for H. pylori on RUT and histology, tested negative for H. pylori on [14C]-UBT. However, of 18 patients shown to have H. pylori infection on RUT and histology, 16 were positive for H. pylori on [14C]-UBT. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [14C]-UBT were 100, 89, 91, 100 and 95% respectively.
  
  
  CONCLUSIONS
  The [14C]-UBT is a reliable indicator of H. pylori eradication after treatment. It can obviate the need for antral biopsies to confirm eradication of H. pylori after completion of treatment.
authors: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: B C
authors: BC
authors: Sharma
authors: D K
authors: DK
authors: Bhasin
authors: C M
authors: CM
authors: Pathak
authors: S K
authors: SK
authors: Sinha
authors: P
authors: P
authors: Ray
authors: K
authors: K
authors: Vaiphei
authors: K
authors: K
authors: Singh
mesh_terms: D000328:Adult; D001944:Breath Tests; D002250:Carbon Radioisotopes; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000382:microbiology*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014508:Urea
chemical_list: D002250:Carbon Radioisotopes; D014508:Urea