THE ¹³C-UREA BREATH TEST REFLECTS THE SEVERITY OF HELICOBACTER PYLORI-ASSOCIATED ANTRAL INFLAMMATION

Geoffrey M Matthews, Ross N Butler, Adrian G Cummins, Andrew Lawrence, Bruce Johnson & Fiona Campbell.
Journal of Paediatric Gastroenterology and Nutrition (2000); Volume 31 Supplement 2: S149

World Congress of Paediatric Gastroenterology, Hepatology, and Nutrition, 5-9 August 2000, Boston, Massachusetts, USA

BACKGROUND: The 13C-urea breath test (13C-UBT) is a highly sensitive and specific method for the detection of Helicobacter pylori (H. pylori) and for determining the success of eradication therapy. This study measured the variation in the 13C-UBT and assessed its ability to reflect the level of H.pylori infection and associated inflammation. Change in the 13C02: 12C02 ratio (DOB 13C), 30 minutes following ingestion of 13C-labelled urea, was compared to the severity of gastric antral inflammation.

METHODS: This study included 65 asymptomatic individuals (54.2 ± 1.8 yrs; 24M: 41F) and 109 symptomatic patients (57.2 ± 1.8 yrs; 48M: 58F). Asymptomatic individuals underwent a screening 13C-UBT. Those H. pylori positive (DOB 13C ³ 5) were required thereafter to undertake 5 further breath tests. Symptomatic patients underwent endoscopy during which antral biopsies (³ 4) were obtained for histopathology and culture. All symptomatic patients then underwent a 13C-UBT. Data are presented as mean ± SEM.

RESULTS: Twenty- one (32%) asymptomatic individuals and thirty- nine (37%) patients were H. pylori positive. An intraindividual coefficient of variation of 26.76 ± 1.56% was obtained. Mean DOB 13C from two 13C-UBT was highly correlated to the mean from six tests (r = 0.97). DOB 13C was significantly higher in H. pylori positive symptomatic patients with a moderate to severe antral gastritis (34.5 ± 4.4; n = 13) compared to those with a mild gastritis (17.7 ± 2.8; n = 14) (P = 0.002) and to H. pylori negative patients with no evident inflammation (1.77 ± 0.13; n = 44) (P < 0.0001).

CONCLUSION: The 13C-UBT is a reliable determinant of H. pylori infection and non-invasively assesses the severity of associated antral inflammation. Further studies are indicated to assess both the prognostic ability of the DOB 13C and the resolution of gastritis post-therapy.