[C-14]-Urea breath test to confirm eradication of Helicobacter pylori

Background: Treatment for Helicobacter pylori reduces ulcer recurrence. Era dication rates of the organism vary with different drug regimens from 30% t o 90%. There is a need to identify patients who have failed treatment. [C-1 4]-Urea breath test (UBT) is non-invasive, sensitive, safe and highly relia ble test for diagnosis of H. pylori infection. As there is a paucity of rep orts on the utility of [C-14]-UBT in confirming H. pylori eradication, this study was undertaken. Methods: Thirty-eight patients (age 34 +/ 17 years, range 16-84 years, 27 m en) with upper gastrointestinal symptoms underwent upper gastrointestinal e ndoscopy. Baseline H. pylori infection was diagnosed by identification of t he organism on antral biopsies and positive rapid urease test (RUT). After I month of completion of treatment, repeat RUT and histological examination of antral endoscopic biopsies were performed. Eradication of H. pylori was defined as absence of the organism on histology, and negative RUT. The [C- 14]-UBT was performed using 185 kBq [C-14]-urea dissolved in 300 mt water. Breath samples were collected once before ingestion of [C-14]-urea, and sub sequently at 5 and 15 min. Results were expressed as (CO2)-C-14/mmol CO2 exhaled as per cent of admini stered urea. Results: Endoscopy revealed antral gastritis (n=14), duodenal ulcer (n=8), duodenitis (n=2), oesophagitis (n=1), antral gastritis and duo denal ulcer (n=3), antral gastritis and duodenitis (n=7) and normal upper g astrointestinal endoscopy (n =3). All the 20 patients who were negative for H. pylori on RUT and histology, tested negative for H. pylori on [C-14]-UB T. However, of 18 patients shown to have H. pylori infection on RUT and his tology, 16 were positive for H. pylori on [C-14]-UBT The sensitivity, speci ficity, positive predictive value, negative predictive value and accuracy o f [C-14]-UBT were 100, 89, 91, 100 and 95% respectively. Conclusions: The [C-14]-UBT is a reliable indicator of H. pylori eradicatio n after treatment. It can obviate the need for antral biopsies to confirm e radication of H. pylori after completion of treatment.