THE HELICOBACTER-PYLORI BREATH TEST - A SURROGATE MARKER FOR PEPTIC-ULCER DISEASE IN DYSPEPTIC PATIENTS

Background-There is interest in non-invasive H pylori testing as a mea ns of predicting diagnosis and determining management in dyspeptic pat ients. Aims-To assess the value of the C-14 urea breath test as a pred ictor of peptic ulcer disease in patients presenting with dyspepsia. P atients and methods-327 consecutive patients referred for investigatio n of dyspepsia had a C-14 urea breath test performed before endoscopy. Patients were not included if they had previously confirmed ulcer dis ease, previous gastric surgery, or were taking non-steroidal anti-infl ammatory drugs. Results-Of the 182 patients with a positive C-14 urea breath test, duodenal and/or gastric ulcers were present in 45% and er osive duodenitis in a further 2%. Oesophagitis was present in 12% of t he breath test positive patients with two thirds of the oesophagitis p atients having co-existent ulcer disease. The prevalence of ulcer dise ase in the H pylori positive dyspeptic patients was independently rela ted to smoking and previous investigation status. If previously uninve stigated, the prevalence of ulcers was 67% in smokers and 46% in non-s mokers. If previous upper gastrointestinal investigations were negativ e, the prevalence of ulcers was 53% in smokers and 28% in non-smokers. Of the 136 patients with a negative breath test, only 5% had peptic u lcers. The most frequent endoscopic finding in these H pylori negative subjects was oesophagitis, being present in 17%. Conclusions-This stu dy demonstrates that a positive H pylori test is a powerful predictor of the presence of underlying ulcer disease in dyspeptic patients, esp ecially if smokers, and that a negative H pylori test is a powerful pr edictor of the absence of ulcer disease. It also indicates that a nega tive upper gastrointestinal investigation does not preclude subsequent presentation with ulcer disease.