C-14 urea breath test does not predict density of Helicobacter pylori in duodenal ulcer disease

Background & objectives: The density of Helicobacter pylori in the gastric mucosa has prognostic significance, higher densities being associated with greater chances of development of duodenal ulcer and chronic atrophic gastr itis as well as poor eradication by drug therapy. The aim of this study was to assess if C-14-urea breath test counts reflect bacterial density. Methods: Sixty patients with endoscopically proven active duodenal ulcer an d H. pylori positivity as determined by rapid urease test and gastric histo logy were studied. Gastric antral and corpus biopsies were graded for chron ic gastritis, activity (presence of polymorphonuclear cells) and bacterial density (at surface and in pits) based on the Sydney system on a scale of f our grades ranging from 0 to 3 (absent, mild, moderate and severe). C-14 ur ea breath test was performed in all the patients. Results: Chronic gastritis as well as activity was more prevalent as well a s severe in the antrum as compared to the corpus. H. pylori density was als o significantly more in the antrum as compared to the corpus both at the su rface as well as in the pits. H. pylori density correlated with the grade o f chronic gastritis and activity both in the antrum and in the corpus. Urea breath test counts ranged from 331.3 cpm (counts per minute) to 8770.5 cpm and these did not correlate with histological H. pylori density at any of the sites. Interpretation & conclusions: 14C urea breath test does not reflect H. pylo ri density on histology in patients of duodenal ulcer disease.