COMPARISON OF HELISAL RAPID BLOOD-TEST AND C-14-UREA BREATH TEST IN DETERMINING HELICOBACTER-PYLORI STATUS AND PREDICTING ULCER DISEASE IN DYSPEPTIC PATIENTS

Objective: Noninvasive tests for Helicobacter pylori are used increasi ngly. Our aim was to compare the Helisal Rapid Blood (HRB) test and C- 14-urea breath test (UBT) for determining H. pylori status and predict ing ulcer disease. Methods: Three hundred fifty-one consecutive patien ts with dyspepsia (mean age 40 yr; range 16-77 yr) had an HRB test and UBT followed by endoscopy with biopsies of the antrum and body for hi stology and antral urease slide test (CLO test). Patients were exclude d if they had previously confirmed ulcer disease, gastric surgery, or anti-H. pylori therapy or were taking nonsteroidal anti-inflammatory d rugs. Results: Sixty-three percent of the patients were ''gold standar d'' H. pylori positive (positive CLO test, positive staining), 34% wer e gold standard negative (negative CLO test, negative staining), and 3 % had conflicting CLO test and histology. The UBT was superior to HRB for determining H. pylori status (sensitivity 98% vs 92%, p = 0.04; sp ecificity 100% vs 69%, p < 0.001). The specificity of the HRB decrease d with increasing patient age (74% for age <46 yr; 57% for age greater than or equal to 46 yr). A negative UBT was superior to a negative HR B test for predicting the absence of ulcer disease (47% vs 36%; p < 0. 01). A positive UBT was similar to a positive HRB in predicting the pr esence of ulcer disease (92% vs 84%; p = 0.23). Conclusions: The HRB t est is inferior to the UBT for determining H. pylori status. The tests have a similar ability to predict the presence of ulcer disease when positive, but a negative UBT is a better predictor of the absence of u lcer disease. (C) 1998 by Am. Coll. of Gastroenterology.