title: Excretion kinetics of 13C-urea breath test: influences of endogenous CO2 production and dose recovery on the diagnostic accuracy of Helicobacter pylori infection.
abstract: We report for the first time the excretion kinetics of the percentage dose of (13)C recovered/h ((13)C-PDR %/h) and cumulative PDR, i.e. c-PDR (%) to accomplish the highest diagnostic accuracy of the (13)C-urea breath test ((13)C-UBT) for the detection of Helicobacter pylori infection without any risk of diagnostic errors using an optical cavity-enhanced integrated cavity output spectroscopy (ICOS) method. An optimal diagnostic cut-off point for the presence of H. pylori infection was determined to be c-PDR (%) = 1.47 % at 60 min, using the receiver operating characteristic curve (ROC) analysis to overcome the "grey zone" containing false-positive and false-negative results of the (13)C-UBT. The present (13)C-UBT exhibited 100 % diagnostic sensitivity (true-positive rate) and 100 % specificity (true-negative rate) with an accuracy of 100 % compared with invasive endoscopy and biopsy tests. Our c-PDR (%) methodology also manifested both diagnostic positive and negative predictive values of 100 %, demonstrating excellent diagnostic accuracy. We also observed that the effect of endogenous CO2 production related to basal metabolic rates in individuals was statistically insignificant (p = 0.78) on the diagnostic accuracy. However, the presence of H. pylori infection was indicated by the profound effect of urea hydrolysis rate (UHR). Our findings suggest that the current c-PDR (%) is a valid and sufficiently robust novel approach for an accurate, specific, fast and noninvasive diagnosis of H. pylori infection, which could routinely be used for large-scale screening purposes and diagnostic assessment, i.e. for early detection and follow-up of patients.
authors.affiliation: Department of Chemical, Biological and Macromolecular Sciences, S.N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, 700098, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Som
authors.forename: Abhijit
authors.initials: A
authors.lastname: Maity
authors.forename: Gourab Dutta
authors.initials: GD
authors.lastname: Banik
authors.forename: Chiranjit
authors.initials: C
authors.lastname: Ghosh
authors.forename: Sujit
authors.initials: S
authors.lastname: Chaudhuri
authors.forename: Sunil Baran
authors.initials: SB
authors.lastname: Daschakraborty
authors.forename: Shibendu
authors.initials: S
authors.lastname: Ghosh
authors.forename: Manik
authors.initials: M
authors.lastname: Pradhan
mesh_terms: D000328:Adult; D000368:Aged; D001944:Breath Tests; D002138:Calibration; D002245:Carbon Dioxide / Q000737:chemistry*; D002247:Carbon Isotopes / Q000737:chemistry*; D005189:False Positive Reactions; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D006868:Hydrolysis; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013053:Spectrophotometry; D014508:Urea / Q000737:chemistry; D055815:Young Adult
chemical_list: D002247:Carbon Isotopes; D002245:Carbon Dioxide; D014508:Urea