Influencing factors of 13C-urea breath test in the diagnosis of Helicobacter pylori infection in children / 中华实用儿科临床杂志

The 13C-urea breath test is the most widely applied non-invasive test to diagnose Helicobacter pylori (Hp) infection in children.The fasting time, dose and formulation of labeled urea, type of test meal, time of breath collection, device to detect breath samples, cut-off value of exhaled 13CO 2/ 12CO 2 breath delta value and the interpretation of results have been modified to improve the accuracy.The 13C-urea breath test possesses a good perfor-mance in diagnosing Hp infection and evaluating the eradication of infection after treatment in children.However, the high false-positive results in young children are caused by oral flora, endogenous CO 2 and fixed dose of labeled urea.In addition, taking proton pump inhibitors, antibiotics and bismuth before test, low bacterial density and peptic ulcer bleeding will lead to false negative results.This study aims to review the influencing factors of 13C-urea breath test in the diagnosis of Hp infection in children.

Performance of the 13C-urea breath test for the diagnosis of H. pylori infection using a substrate synthesized in Brazil: A preliminary study

OBJECTIVE: The 13C-urea breath test is the main non-invasive test for the diagnosis of Helicobacter pylori infection. The availability of this test throughout the country is limited, mainly due to the difficulty in obtaining the labeled isotope from abroad. Recently, researchers from the Nuclear Energy Center in Agriculture at the University of São Paulo (CENA/USP) succeeded in synthesizing 13C-enriched urea for Helicobacter pylori diagnosis. The aim of the study was to compare the performance of the 13C-urea breath test using 13C-urea acquired abroad with that of a test using 13C-urea synthesized in Brazil. METHOD: Sixty-four dyspeptic patients participated in the study (24 men and 40 women). Initially, the patients performed the 13C-urea breath test using the imported substrate (Euriso-Top, France). Seven to fourteen days later, all the patients repeated the test using the Brazilian substrate. The samples from both examinations were processed in an infrared isotope analyzer (IRIS, Wagner Analisen Technik, Germany), and all delta over baseline (DOB) [%] values above four were considered positive results. RESULTS: Twenty-seven patients (42%) exhibited negative results for Helicobacter pylori infection, and thirty-seven patients (58%) exhibited positive results when tested using the foreign substrate (gold standard). There was a 100% concordance regarding the presence or absence of infection when the gold standard results were compared with those obtained using the Brazilian substrate. CONCLUSIONS: Similar performance in the diagnosis of Helicobacter pylori infection was demonstrated when using the 13C-urea breath test with the Brazilian 13C-urea substrate and the test with the substrate produced abroad. This validation represents an important step toward increasing the availability of the 13C-urea breath test throughout the country, which will have a positive influence on the management of Helicobacter pylori infection.

Analysis of the current infection status and risk factors of Helicobacter pylori among people taken physical examination in Miyun area of Beijing / 中国综合临床

Objective To analyze the infection status and possible risk factors of Helicobacter pylori among people taken physical examination in Miyun area of Beijing,so as to establish effective intervention measures scientifically.Methods From January 2012 to December 2016,eleven thousand physical examinees in Beijing MIyun Hospital were enrolled in this study,13C-urea breath test was used to detect Helicobacter pylori infection and a face to face questionnaire survey was applied.The data colleted was analyzed based on sex,age, living habits.Results The overall infection rate of Hp was 46.72%(5139/11000),the rate of male infection was higher than that of female(49.74%(2826/5682)vs.43.49%(2313/5318)),and the difference was statistically significant(χ2=43.000,P<0.000).The physical examinees were divided into 4 groups by 20 years for age.The infection rates of Hp in the<20 years old group,20—39 years old group,40-59 years old group,>60 years old group were 36.17%,47.28%,48.04%,43.59%,respectively.The infection rate before the age of 60 was on the rise,and the infection rate was the highest in the 40-59 year group,the lowest in the<20 years old group.There was significant difference among the 4 groups(χ2=23.694,P=0.000).The Hp infection rate in people who smoked,had a large number of family members and preferred a hot diet,a dinner party and no hand washing habits was significantly higher than those without related habits,the differences were statistically significant(P<0.05).Conclusion The infection rate of Hp infection in the MIyun area is lower than that of the national average.The infection distribution is closely related with sex,age and living habits.Health education should be strengthened and the occurrence of food-borne disease should be prevented to reduce the Hp infection rate.

Analysis of the current infection status and risk factors of Helicobacter pylori among people taken physical examination in Miyun area of Beijing / 中国综合临床

Objective To analyze the infection status and possible risk factors of Helicobacter pylori among people taken physical examination in Miyun area of Beijing,so as to establish effective intervention measures scientifically.Methods From January 2012 to December 2016,eleven thousand physical examinees in Beijing MIyun Hospital were enrolled in this study,13C-urea breath test was used to detect Helicobacter pylori infection and a face to face questionnaire survey was applied.The data colleted was analyzed based on sex,age, living habits.Results The overall infection rate of Hp was 46.72%(5139/11000),the rate of male infection was higher than that of female(49.74%(2826/5682)vs.43.49%(2313/5318)),and the difference was statistically significant(χ2=43.000,P<0.000).The physical examinees were divided into 4 groups by 20 years for age.The infection rates of Hp in the<20 years old group,20—39 years old group,40-59 years old group,>60 years old group were 36.17%,47.28%,48.04%,43.59%,respectively.The infection rate before the age of 60 was on the rise,and the infection rate was the highest in the 40-59 year group,the lowest in the<20 years old group.There was significant difference among the 4 groups(χ2=23.694,P=0.000).The Hp infection rate in people who smoked,had a large number of family members and preferred a hot diet,a dinner party and no hand washing habits was significantly higher than those without related habits,the differences were statistically significant(P<0.05).Conclusion The infection rate of Hp infection in the MIyun area is lower than that of the national average.The infection distribution is closely related with sex,age and living habits.Health education should be strengthened and the occurrence of food-borne disease should be prevented to reduce the Hp infection rate.

Relationship of Helicobacter pylori infection and carotid plaques in patients with coronary heart disease / 中国医师进修杂志

Objective To explore the relationship of Helicobacter pylori (Hp) infection and carotid plaques in patients with coronary heart disease and analyze the related factors of carotid plaques.Methods This study enrolled 209 patients.13C-urea breath test (13C-UBT) was used to assess Hp infection.Based on the results of 13C-UBT,patients were divided into infection-positive group (101 patients) and infection-negative group (108 patients).The incidence of carotid plaques was detected by color Doppler,and plasma homocysteine (Hcy),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),fibrinogen (Fbg),high sensitivity C reactive protein (hs-CRP) were measured and compared.Results The incidence of carotid plaques in infection-positive group(69.31％,70/101) was higher than that in infection-negative group (55.56％,60/108),and there was significant difference (P =0.040).There was significant difference in hs-CRP between infection-positive group and infection-negative group [(3.91 ± 1.91) mg/L vs.(2.65 ± 1.15)mg/L] (P =0.041).There were no significant difference in Hcy,TC,LDL-C,Fbg between infection-positive group and infection-negative group (P ＞ 0.05).Logistic regression analysis showed that Hp infection was correlated with carotid plaques in patients with coronary heart disease.The severity of Hp infection had no significant effect on the incidence of carotid plaques.Conclusions Hp infection-positive patients with coronary heart disease may have a higher incidence of carotid plaque,regardless of Hcy,LDL-C,Fbg and TC level.This study shows that Hp is correlated with carotid plaque.The severity of Hp infection has no significant effect on the incidence of carotid plaque.

Clinical value of three kinds of helicobacter pylori detection methods / 重庆医学

Objective To discuss the clinical value of three kinds of helicobacter pylori (HP) detection methods and find out the appropriate method for clinical application of the HP detection .Methods A total of 109 patients received gastroscopy ,the efficacy of RUT ,13C-urea breath test(13C-UBT) and the immunoCard STAT helicobacter pylori stool antigen (HpSA) for detection of HP were compared .Results RUT positive rate of the two pieces of gastric mucosa (the gastric antrum and the gastric body) was 34 .86% ,higher than that of single piece of gastric mucosa (gastric antrum or stomach body ) and two pieces of gastric mucosa (stomach) ,the difference was statistically significant (P0 .05) .The diagnosis of HP infection was based on 13C-UBT ,the immunoCard STAT HpSA sensi-tivity ,specificity and accuracy were 86 .49% ,95 .83% ,92 .66% ,respectively ,which were higher than RUT .Conclusion Two pieces of gastric mucosa (the gastric antrum and the gastric body) materials is appropriate for clinical promotion RUT based solution . RUT ,13C-UBT and hpsas immune quick check card are all clinical detection of HP and reliable methods ,but hpsas immune quick check card is more suitable for clinical promotion .

La trombocitopenia inmune como manifestación de la infección por Helicobacter pylori / Immune thrombocytopenia as a manifestation of Helicobacter pylori infection

Resumen: Helicobacter pylori es el agente causal de la infección más frecuente de la especie humana, con una marcada desventaja entre los países desarrollados y los países en vía de desarrollo. Si bien, la infección por Helicobacter pylori cursa asintomática en la mayoría de los individuos infectados, también es claro que está íntimamente relacionada con enfermedades malignas del estómago como el cáncer gástrico y el linfoma MALT gástrico; y enfermedades benignas como la gastritis crónica y la úlcera péptica duodenal y gástrica. A partir del momento en que se conoció que la mucosa gástrica podía ser colonizada por una bacteria, en la literatura médica mundial indexada (PubMed) se han informado alrededor de una centena de manifestaciones extragástricas que involucran a especialidades médicas tan disímiles como la cardiología, la dermatología, la endocrinología, la ginecobstetricia, la hematología, la neumología, la neurología, la odontología, la oftalmología, la otorrinolaringología, la pediatría, la siquiatría y vascular periférico, algunas de ellas con mayor o menor acervo probatorio entre la infección por Helicobacter pylori y el desarrollo de la enfermedad. Esta revisión de la literatura médica mundial se centra en el análisis de la relación de la infección por Helicobacter pylori con la trombocitopenia inmune (ITP), antes conocida como púrpura trombocitopénica idiopática. Se presenta una visión global de la ITP, las evidencias de la asociación con la infección por Helicobacter pylori, la fisiopatología y el manejo de ésta en la era poshelicobacter.

Abstract: Helicobacter pylori is the most common causative agent of human infection, with a marked disadvantage between developed and developing countries. Although Helicobacter pylori infection is asymptomatic in majority of individuals infected, it is also clear their close relation with malignant diseases of the stomach as gastric cancer and gastric MALT lymphoma and benign diseases such as chronic gastritis and duodenal and gastric peptic ulcer. Since the moment it became know that bacteria could colonize the gastric mucosa, hundred extragastric events have been reported in the indexed world medical literature (PubMed), that involves medical specialties as diverse as cardiology, dermatology, endocrinology, obstetrics and gynecology, hematology, pulmonology, neurology, dentistry, ophthalmology, otolaryngology, pediatrics, psychiatry and peripheral vascular. Some of these with varying proofs of relation between Helicobacter pylori infection and disease development. This review focuses in the analysis of the relationship between Helicobacter pylori infection and immune thrombocytopenia (ITP), known as idiopathic thrombocytopenic purpura. The information for ITP includes the problem overview, evidence of the association with Helicobacter pylori infection, the pathophysiology and managementin poshelicobacter era.

Validation of a rapid stool antigen test for diagnosis of Helicobacter pylori infection / Validação de teste rápido de antígeno fecal para diagnóstico de infecção por Helicobacter pylori

The aim of this study was to validate the rapid lateral flow Helicobacter pylori stool antigen test (One step H. pylori antigen test, ACON laboratories, San Diego, USA; Prime diagnostics, São Paulo), using 13C-Urea Breath Test as the gold standard for H. pylori infection diagnosis. A total of 98 consecutive patients, asymptomatic or dyspeptic, entered the study. Sixty-nine were women, with a mean age of 45.76 ± 14.59 years (14 to 79 years). In the H. pylori-positive group, the rapid stool antigen test detected H. pylori antigen in 44 of the 50 positive patients (sensitivity 88 percent; 95 percent CI: 75.7-95.5 percent), and six false-negative; and in the H. pylori-negative group 42 presented negative results (specificity 87.5 percent; 95 percent CI: 74.7-95.3 percent), and six false-positive, showing a substantial agreement (Kappa Index = 0.75; p < 0.0001; 95 percent CI: 0.6-0.9). Forty four of fifty patients that had positive stool antigen were H. pylori-positive, the PPV of the stool antigen test was 88 percent (95 percent CI: 75.7-95.5 percent), and 42 patients with negative stool antigen test were H. pylori-negative, the NPV of the stool antigen test was 87.5 percent (95 percent CI: 74.7-95.3 percent). We conclude that the lateral flow stool antigen test can be used as an alternative to breath test for H. pylori infection diagnosis especially in developing countries.

O objetivo desse trabalho foi avaliar o teste rápido de antígeno de H. pylori nas fezes (One step H. pylori antigen test, ACON laboratories, San Diego, USA; Prime diagnostics, São Paulo), usando teste respiratório com uréia marcada com 13C (TRU-13C), como padrão ouro. Noventa e oito pacientes assintomáticos ou com dispepsia participaram do estudo. Sessenta e nove eram mulheres; a média de idade dos pacientes foi de 45.76 ± 14.59 (14 a 79 anos). No grupo H. pylori positivo, o teste rápido detectou antígenos de H. pylori nas fezes em 44 dos 50 pacientes positivos (sensibilidade de 88 por cento; 95 por cento IC: 75.7-95.5 por cento), com seis falso-negativos; e no grupo H. pylori negativo, 42 apresentaram resultados negativos (especificidade de 87,5 por cento; 95 por cento IC: 74.7-95.3 por cento), com seis falso-positivos, mostrando concordância substancial (índice Kappa = 0.75; p < 0.0001; 95 por cento IC: 0.6-0.9). Quarenta e quatro dos 50 que tiveram teste de antígeno fecal positivo eram H. pylori positivos, sendo o VPP do teste 88 por cento (95 por cento IC: 75.7-95.5 por cento), e 42 pacientes com teste de antígeno fecal negativo eram H. pylori negativos, com VPN de 87,5 por cento (95 por cento IC: 74.7-95.3 por cento). Concluímos que o teste de antígeno fecal imunocromatográfico pode ser usado como alternativa ao teste respiratório para diagnóstico de infecção pelo H. pylori, principalmente em países em desenvolvimento.

Validity of 38 mg Low Dose 13C-Urea Breath Test for the Diagnosis of Helicobacter pylori Infection

BACKGROUND: To assess the diagnostic value of 13C-UBT using capsulated 38 mg low dose for H. pylori infection, we investigated the sensitivity and specificity of 13C-UBT and to suggest the optimal positive cut-off value of DOB20 in 13C-UBT using ROC analysis. METHODS: The study subjects were 76 healthy individuals (males; 52, females; 24) who visited a health promotion center at a university hospital between July 2005 and June 2007. We tested for H. pylori infection by 38 mg low dose 13C-UBT and histology. We measured the expiratory 13C-urea concentration of basal and 20 minutes value after oral ingestion of 38 mg 13C- labelled urea with capsulated. The breath samples were analysed by gas chromatograph isotope ratio mass spectrometer and expressed as units of delta. RESULTS: Fifty subjects (65.8%) were H. pylori positive as judged from histology. ROC analysis showed an area under the curve (AUC) of 0.943 (95% confidence interval: 0.891~0.995), indicating an excellent classification performance of the model. The sensitivity of 96%, specificity of 85% were achieved at the optimal cut-off value of DOB20 which was 1.39. The 38 mg low dose 13C-UBT was a non-invasive, simple, short-time required and highly accurate method. CONCLUSION: The results suggested that capsulated 38 mg low dose 13C-UBT is considered more in term of accuracy, costeffectiveness and convenient method for the diagnosis of H. pylori infection. Further long-term research and meta analysis based on large-scale investigations is needed to establish a standardized testing method in creating protocol of 13C-UBT.

Helicobacter pylori reinfection rate by a (13)C-urea breath test and endoscopic biopsy tests in Korean children / 소아과

PURPOSE: The reinfection rate of H. pylori reported before (13)C-urea breath test((13)C-UBT) era was higher than that of the post (13)C-UBT era. Children are usually reluctant to receive invasive endoscopic evaluation for the reinfection of H. pylori, particularly when they are asymptomatic. The aim of the study is to discover the reinfection rate by different diagnostic tests, and to find out what causes the difference. METHODS: Children confirmed to be eradicated from H. pylori were included in the study. Reinfection was evaluated by endoscopic biopsy based tests(n=34, mean age 11.5+/-3.7 years) and/or a (13)C-UBT(n=38, mean age 10.0+/-3.6 years) at the time of 18 months after eradication. At first visit, H. pylori infection had been diagnosed by positive results from a rapid urease test, Giemsa stain and Warthin-Starry stain and/or a positive culture. Eradication was defined as negative results from all above tests 1-3 months after eradication therapy. RESULTS: Reinfection rate by endoscopic biopsy based tests was 35.3 percent(12/34). All patients had abdominal symptoms(P=0.000). Reinfection rate was 13.2 percent(5/38) by a (13)C-UBT. Reinfection rate was higher in children with abdominal symptoms(P=0.008). There was no evidence that reinfection rate depended on the sex(P=0.694), age(P=0.827), diseases(peptic ulcers vs gastritis, P=0.730) and eradication regimen(P=0.087). CONCLUSION: Helocibacter pylori reinfection rate in Korean children was 13.2 percent per 18 months by a non-invasive test or (13)C-UBT. Accurate determinations of the reinfection rate in children is affected by the compliance of the diagnostic tests. Non-invasive tests should be considered to investigate the reinfection rate in children.

Variance of Helicobacter Pylori Infection Rate in Children with Recurrent Abdominal Pain / 实用儿科临床杂志

Objective To explore the variance of helicobacter pylori(Hp) infection rate in children with recurrent abdominal pain(RAP).Methods By using the()~(13)C-urea breath test(~(13)C-UBT) to detect the status of Hp infection in 1676 children with RAP from 1998 to 2004.Results 1.Total 1676 cases of children with RAP were detected.There were 438 cases showed Hp positive,the positive rate was 26.13%.The infection rates in patients from 2-5,5-10,and 10-14 years of age were 23.66%(84/355),(26.31%)(286/1087),29.06%(68/234),respectively.2.Hp infection rates in children with RAP from 1998 to 2004 were 29.33%(83/283),(28.90%)(76/263),25.76%(51/198),26.01%(56/215),25.81%(48/186),24.45%(67/274),22.18%(57/257),respectively.Conclusion 1.The Hp infection rate in children with RAP increased with age;2.The Hp infection rate in children with RAP decreased year after year.

A prospective study of Helicobacter pylori reinfection rate and related factors in Gyeongju-si residents / 대한내과학회지

BACKGROUND: High prevalence of Helicobacter pylori (H. pylori) in developing countries may result in high reinfection rate after eradication therapy, but there were few studies on H. pylori reinfection, especially in community population. The aim of this study was to investigate the one -year reinfection rate of H. pylori after successful eradication therapy and the factors related to the reinfection of H. pylori in community population. METHODS: 86 persons who had been confirmed as H. pylori-negative by 13C-urea breath test were included. They were ones of 181 persons treated by eradication regimen one year ago because of H. pylori-positive in serologic H. pylori antibody test and rapid urease test. The reinfection rate of H. pylori and the factors related to the reinfection of H. pylori were investigated after one-year follow-up. The subjects were confirmed as H. pylori reinfection by repetitive 13C-urea breath test and asked to answer the questionnaire regarding demographic characteristics, dyspepsia symptoms, health-related behaviors and family history. RESULTS: The one-year reinfection rate was 18.6% in this study. The one-year reinfection rate of the subjects who aged above 50 years was 23.4% (p < 0.05). The symptom score (total 5) was positively related to H. pylori reinfection (p < 0.05). In multivariate logistic regression analysis, the subjective symptom score was the significant factor in predicting H. pylori positivity by 13C-urea breath test (OR=4.5, p < 0.05). CONCLUSION: During 1 year period after successful H. pylori eradication, the reinfection rate of H. pylori was 18.6%. The subjective symptom score survey by questionnaire may be useful predictor of H. pylori reinfection in community setting.

Evaluation of the Helicobacter pylori stool antigen test for the detection of Helicobacter pylori infection before and after eradication / 中华消化杂志

Objective The aim of this study was to assess the reliability of a newly developed enzymeimmumoassay, the Helicobacter pylori (H. pylori) stool antigen (HpSA) test, for the detection of H.pylori infection before and after eradication. Methods The H.pylori infected patients referred to our department were included. They were divided into two groups. The 331 patients in group A had intact stomach, and 65 patients in group B had history of subtotal gastrectomy. All patients underwent gastroscopy with biopsies for rapid urease test (RUT) and histology, which was viewed as “gold standard”. H.pylori status was defined as positive or negative with both RUT and histology presenting concordant positive or negative results. The results of these reference tests were compared with those obtained by HpSA test and ()~(13)C-urea breath test (()~(13)C-UBT). In addition, Fifty-six-positive patients in group A, constituting group C, were treated with 1-week triple therapy. At the 28 th day after the end of therapy, the patients underwent another ()~(13)C-UBT which was also defined as “gold standard”. The stool specimens were collected on days 1, 7, 14, 21, and 28 after completion of therapy and were used to detect the antigen of H.pylori by HpSA. Results In group A, 175 patients were defined as H.pylori-positive and 156 as negative by the “gold standard”. The sensitivity and specificity of the HpSA test was (95.4%) and 91.0%, respectively. There was no significant difference between HpSA test and ()~(13)C-UBT. In group B, 30 patients were defined as H.pylori-positive and 35 as negative by the “gold standard”. The sensitivity of the HpSA test and ()~(13)C-UBT was 90.0% and 66.7%, respectively (P

Clinical Validity of 13C - Urea Breath Test for the Diagnosis of Helicobacter pylori Infection: A Multi-Center, Open, and Noncomparative Trial / 대한내과학회지

OBJECTIVE: Helicobacter pylori(H. pylori) infection plays an importanat role in the pathophysiology of gastrointestinal diseases, and its diagnosis is crucial in clinical practice. Currently many diagnostic methods are introduced for its simple, and accurate diagnosis. 13C urea breath test(13C-UBT) is a convenient, non-invasive and reliable test for the diagnosis of H. pylori infection. To assess the clinical value of the 13C-UBT, we examined the sensitivity, specificity of 13C-UBT with regard to other tests. METHODS: A prospective multicenter study was done in 107 subjects(mean age 36 years, 55 males, 52 females) presenting for endoscopy from three university hospitals. We tested for H. pylori infection by 13C-UBT, serum IgG antibody level, and multiple biopsies for rapid urease testing and histology. Either a positive histology result or a combined positive CLO test and IgG ELISA in the presence of a negative histology results, was interpreted as a positive finding for H. pylori infection. 13C-UBT was performed after 4hrs fast. Breath samples were collected at 0 and 30 minutes after giving 75mg 13C-urea. RESULTS: Results were analysed by isotope ratio mass spectrometry and expressed as units of delta( 13C, 13CO2 /12CO2) and considered as positive for H. pylori if delta value was greater than 4.0. Sensitivity and specificity of 13C-UBT were 94.5%, and 100% respectively. No significant adverse events were noted. CONCLUSIONS: The 13C-UBT offers an easy, safe and accurate approach to the diagnosis of H. pylori infection in routine clinical practice

Analysis of the result of ~(13) C-urea breath test in detection of Helicobacter pylori infection in gastric cancer patients / 中国现代普通外科进展

Objective:To study the relationship between detection of Helicobacter pylori(H.pylori)infection with 13 C urea breath test( 13 C UBT)and gastric cancer.Methods: 13 C UBT were carried out in 53 cases of gastric cancer patients at 3 days before operation and 10 days after operation.Thirty six healthy individuals were detected as normal control.The rate of H.pylori infection in gastric cancer patients was calculated and compared.Results:The rate of H.pylori infection of the healthy control group was 0,but that of the early or advanced gastric cancer groups were 75% and 65.8% respectively (P