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Abstract
BackgroundHelicobacter pylori causes peptic ulcer disease and gastric cancer only in a subset of infected persons. Sex differences were shown in results of urea breath test (UBT), a commonly used test for the diagnosis of H. pylori infection. However, factors that might explain these differences, or affect UBT values, are not fully understood. We examined differences in UBT values between H. pylori-infected men and women while adjusting for background characteristics such as age, body mass index (BMI), and smoking.MethodsA cross-sectional study was undertaken using coded data from the computerized database of Maccabi Health Services in Israel. Included were adults examined for UBT during 2002–2012 and were found H. pylori positive (UBT > 3.5‰). Multivariable linear mixed models were performed to assess the relationship between sex and UBT quantitative results, while adjusting for background characteristics.ResultsA total of 76,403 patients were included (52% of examined patients during the study period). Adjusted mean UBT value was significantly higher in women 33.8‰ (95% CI 33.4, 34.1) than in men 24.9‰ (95% CI 24.5, 25.3). A significant (P < 0.001) interaction was found between sex and smoking, showing diminished sex-differences in UBT results in smokers. Adjusted mean UBT values increased significantly with age and decreased with BMI, and it was higher in people who lived in low vs high socioeconomic status communities and lower in smokers vs non-smokers.ConclusionsSystemic differences exist between men and women in quantitative UBT results. Host-related and environmental factors might affect UBT quantitative results. These findings have clinical implications regarding confirmation of the success of H. pylori eradication after treatment in various subgroups.
Highlights
Helicobacter pylori causes peptic ulcer disease and gastric cancer only in a subset of infected persons
urea breath test (UBT) is based on urease activity of H. pylori and its ability to hydrolyze orally ingested isotopically labeled urea (13C or 14C urea) into ammonia and labeled carbon dioxide (CO2), which is eventually exerted through the lungs in exhaled breath [10, 13]
Men had a higher mean body mass index (BMI) than women, 26.6 kg/m2 (SD 4.1) vs 25.5 kg/m2 (SD 5.1), P < 0.001, and were smokers more often compared to women, 19.5 vs 10.7%, P < 0.001
Summary
Helicobacter pylori causes peptic ulcer disease and gastric cancer only in a subset of infected persons. Sex differences were shown in results of urea breath test (UBT), a commonly used test for the diagnosis of H. pylori infection. Most H. pylori-infected persons remain asymptomatic, but some might develop peptic ulcer disease and gastric cancer [1,2,3,4]. Men have higher risk for peptic ulcers [5] and gastric cancer [6, 7] compared to women, the difference between sexes in H. pylori infection prevalence is small [8]. UBT is based on urease activity of H. pylori and its ability to hydrolyze orally ingested isotopically labeled urea (13C or 14C urea) into ammonia and labeled carbon dioxide (CO2), which is eventually exerted through the lungs in exhaled breath [10, 13]. DOB values were shown to be positively correlated with gastric H. pylori bacterial load or density and severity of gastritis [14,15,16,17,18]
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