13C urea breath test for (Helicobacter pylori): determination of the optimal cut-off point in a Canadian community population.
OBJECTIVE
To determine the test characteristics and the optimal cut-off point for the (13)C urea breath test ((13)C UBT) in a Canadian community laboratory setting.


METHODS
Of 2232 patients (mean age +/- SD: 51+/-21 years, 56% female) who completed a (13)C UBT, 1209 were tested to evaluate the primary diagnosis of (Helicobacter pylori) infection and 1023 were tested for confirmation of eradication following treatment. Cluster analysis was performed on the (13)C UBT data to determine the optimal cut-off point and the risk of false-positive and false-negative results. Additionally, 176 patients underwent endoscopic biopsy to allow validation of the sensitivity and specificity of the (13)C UBT against histology and microbiology using the calculated cut-off point.


RESULTS
The calculated cut-off points were 3.09 delta/1000 for the whole study population (n=2232), 3.09 delta/1000 for the diagnosis group (n=1209) and 2.88 delta/1000 for the post-treatment group (n=1023). When replacing the calculated cut-off points by a practical cut-off point of 3.0 delta/1000, the risk of false-positive and false-negative results was lower than 2.3%. The (13)C UBT showed 100% sensitivity and 98.5% specificity compared with histology and microbiology (n=176) for the diagnosis of active (H pylori) infection.


CONCLUSIONS
The (13)C UBT is an accurate, noninvasive test for the diagnosis of (H pylori) infection and for confirmation of cure after eradication therapy. The present study confirms the validity of a cut-off point of 3.0 delta/1000 for the (13)C UBT when used in a large Canadian community population according to a standard protocol.
Mauro
Marina
M
Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario.
Radovic
Vladimir
V
Zhou
Pengfei
P
Wolfe
Melanie
M
Kamath
Markad
M
Bercik
Premsyl
P
Croitoru
Ken
K
Armstrong
David
D
D001706:Biopsy; D001944:Breath Tests; D002247:Carbon Isotopes; D003937:Diagnosis, Differential; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014508:Urea
D002247:Carbon Isotopes; D014508:Urea