Eradication of Helicobacter pylori can be accurately confirmed 14 days after termination of triple therapy using a high-dose citric acid-based 13C urea breath test.
BACKGROUND
Confirmation of Helicobacter pylori eradication by urea breath test (UBT) is currently performed 4-6 weeks after completion of therapy because of unacceptable false-negative results in UBTs performed earlier. Use of a high-dose citric acid test meal appears to enable accurate detection of H. pylori even during short term therapy with proton pump inhibitors.


OBJECTIVE
To evaluate if use of a high dose citric acid (4.0 g) test meal can decrease the interval required for confirmation of eradication after triple therapy.


METHODS
233 patients positive for H. pylori were randomized to undergo UBT at 7 days or 14 days after triple therapy, and again at 6 weeks. The latter test was considered the gold standard test.


RESULTS
The UBT performed 6 weeks after the end of treatment found that 79.9% were cured. The same test 7 days after therapy found false-negative detection of H. pylori in 7.3% patients compared to 3.2% patients examined after 14 days. The sensitivity, specificity, positive and negative predictive values and accuracy for evaluation on day 14 were 80, 100, 100, 96.3 and 96.7%, respectively.


CONCLUSIONS
High-dose citric acid-based UBT is a valid test for the assessment of H. pylori status 14 days after triple therapy. This may obviate the delay in instituting second-line eradication therapy, or further evaluation of the symptomatic patient unresponsive to therapy despite eradication.
Shirin
Haim
H
Department of Gastroenterology, The E. Wolfson Medical Center, Holon, Tel-Aviv University, Tel Aviv, Israel. shirin@wolfson.health.gov.il
Levine
Arie
A
Shevah
Orit
O
Shabat-Sehayek
Vered
V
Aeed
Hussein
H
Wardi
Joram
J
Birkenfeld
Shlomo
S
Eliakim
Rami
R
Avni
Yona
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes; D019343:Citric Acid; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012459:Salicylates / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014508:Urea
D000900:Anti-Bacterial Agents; D002247:Carbon Isotopes; D009942:Organometallic Compounds; D012459:Salicylates; D019343:Citric Acid; C015715:bismuth subsalicylate; D014508:Urea; D001729:Bismuth