Diagnostic accuracy of C-13-urea breath test in the diagnosis of Helicobacter pylori infection in patients with partial gastric resection due to peptic ulcer disease - A prospective multicenter study

Aims: We investigated the diagnostic properties of the C-13-urea breath tes t (C-13-UBT) prospectively. These are well validated in nonresected patient s before and after treatment of Helicobacter pylori infection but not in pa tients with partial gastric resection due to peptic ulcer disease. Methods: Hospitalized patients with previous gastric resection and indications for upper gastrointestinal endoscopy were recruited for the study. Biopsy speci mens were obtained from the fundus mucosa and the gastric remnant adjacent to the gastroenteric anastomosis for histological examination and rapid ure ase test (HUT test). Histological slides were evaluated after hematoxylin a nd eosin and Warthin-Starry dye staining. 200 ml orange juice was given ora lly after two baseline breath samples had been taken, and 30 min after inge stion of 75 mg C-13 urea two more breath samples were obtained and analyzed by ratio mass spectrometry. The Warthin-Starry dye-stained sample was take n as reference. Results: 68 patients (47 male, 21 female, mean age 62 years ; 52 Billroth II resection, 17 Billroth I resection) were included in the s tudy. The overall prevalence of histologically proven H. pylori infection w as 36.7%. The sensitivity of the C-13-UBT was 52%, the specificity 93%. The positive predictive value was 81.25%, the negative predictive value 76.9% and the accuracy was 77.9%. The sensitivity of the HUT test reached 60%, an d the specificity 97%.Conclusion: The diagnostic accuracy of C-13-UBT compa red with the Warthin-Starry dye staining is low. The breath test, performed in the above-described manner, cannot be recommended as a noninvasive diag nostic tool for diagnosis of H. pylori infection in patients after partial gastrectomy as a result of peptic ulcer disease. Copyright (C) 2001 S. Karg er AG, Basel.