Duplicate breath testing to confirm eradication of Helicobacter pylori: incremental benefit and cost in 419 patients.
BACKGROUND
Current standards for establishing a cure of H. pylori infection require two breath tests taken at least 4 weeks apart, to be negative.


OBJECTIVE
To determine the incremental cost and accuracy of repeating a urea breath test (UBT) in clinical practice.


METHODS
We identified 419 patients with documented Helicobacter pylori infection who received eradication therapy and then had two breath tests, one 4 weeks and the second at least 8 weeks after the completion of treatment. H. pylori infection was documented at baseline by a positive rapid urease test and histology.


RESULTS
In patients with successful eradication of H. pylori infection (n = 317), the mean +/- standard deviation delta over baseline (DOB) value before treatment was 43 +/- 29 ppm. Following treatment, the mean DOB in cured was 0.56 +/- 2.1 ppm at 1 month and was similar to the value obtained at the second breath (0.68 +/- 1; P = 0.39), which was performed 60 +/- 71 days after the first UBT. In patients remaining infected (n = 102), the mean DOB at baseline was 47 +/- 20 ppm. Four weeks after treatment, the DOB was 40 +/- 32 ppm. The second UBT was performed 94 +/- 72 days after the first and the DOB was significantly greater than the first (47 +/- 28; P = 0.040). There was no discordant result between the first breath test and second breath test. At a cost of 30 euros/breath test, the incremental cost of a second breath test was 12 570 euros in this cohort with no incremental clinical benefit.


CONCLUSIONS
A single UBT, 4 weeks after treatment is as effective as two serial breath tests in confirming H. pylori eradication. The incremental cost of the second breath test is very high with no incremental clinical benefit.
Vakil
N
N
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Zullo
A
A
Ricci
C
C
Hassan
C
C
Vaira
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001944:Breath Tests / Q000379:methods; D002247:Carbon Isotopes; D017291:Clarithromycin / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005773:Gastroscopy / Q000191:economics; D017048:Health Care Costs; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D013276:Stomach Ulcer / Q000188:drug therapy / Q000382:microbiology; D014508:Urea; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002247:Carbon Isotopes; D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin