Can the C-14 Urea Breath Test Replace Follow-Up Endoscopic Biopsies in Patients Treated for Helicobacter Pylori Infection?

• Published in: Clinical nuclear medicine 1998-12, Vol.23 (12), p.815-819
• Main Authors: AHUJA, VINEET, BAL, CHANDRESKHAR S, SHARMA, MAHESH PRAKASH
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Anti-Bacterial Agents - therapeutic use; Anti-Ulcer Agents - therapeutic use; Biological and medical sciences; Biopsy; Breath Tests; Carbon Radioisotopes; Digestion. Liver. Biliary tract. Spleen. Pancreas; Drug Therapy, Combination; Duodenal Ulcer - drug therapy; Duodenal Ulcer - microbiology; Duodenum - pathology; Female; Follow-Up Studies; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori - isolation & purification; Humans; Investigative techniques, diagnostic techniques (general aspects); Lansoprazole; Male; Medical sciences; Omeprazole - analogs & derivatives; Omeprazole - therapeutic use; Predictive Value of Tests; Prospective Studies; Radionuclide investigations; ROC Curve; Time Factors; Urea
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/00003072-199812000-00005

BACKGROUND:The C-14 urea breath test (UBT) is the most specific noninvasive test to detect Helicobacter pylori, with reported sensitivity and specificity rates of 90% and 95%, respectively. This test has not been evaluated for eradication after a therapeutic trial. The goal of this study was to assess the accuracy of C-14 UBT in the diagnosis and eradication of H. pylori infection in patients with duodenal ulcer who were treated with a triple drug regimen. METHODS:Sixty patients with active duodenal ulcers who tested positive for the rapid urease test had a C-14 UBT at 0 weeks (at enrollment) and at 6 and 12 weeks using 5 μCi (185 KBq) of C-14 urea. A single breath sample was collected at 15 minutes for UBT. H. pylori was eradicated using lansoprazole and two antibiotics. RESULTS:Receiver operator characteristic curves showed that, using a value of 400 counts per minute (cpm), UBT had a sensitivity rate of 91%, specificity rate of 93%, positive predictive value of 77%, and a negative predictive value of 97% in the prediction of H. pylori eradication. The mean + 3 SD of H. pylori-negative patients was 380.1 cpm; at this cutoff value, the sensitivity and specificity rates were 91.3% and 92.8%, respectively. CONCLUSION:The C-14 UBT was an accurate, rapid, and easily administered test to diagnose initial H. pylori infection and to monitor its eradication, thereby obviating the need for repeated endoscopic biopsies.