13C Urea Research Articles

Prophylactively parking sodium in the plant

Prophylactively parking sodium in the plant

Validity and cost comparison of14carbon urea breath test for diagnosis ofH Pyloriin dyspeptic patients

To validate and compare the cost of microdose 14C urea breath test (UBT) with histology and rapid urease test for the diagnosis of H Pylori. Ninety-four consecutive patients with dyspeptic symptoms undergoing gastroscopy were enrolled. Gastric biopsies were taken for histology and rapid urease test. UBT was performed after gastroscopy by microdose 14C urea capsules. Sensitivity, specificity and accuracy of UBT were calculated and compared with histology and rapid urease test. Cost comparison of these tests was also performed. H pylori was diagnosed by histology and rapid urease test in 66 (70%) and 61 (65%) patients, while 14C UBT detected infection in 63 (67%). Accuracy of UBT was 93% in comparison with histology while its positive and negative predictive values were 97% and 84%, respectively. Comparison of 14C UBT with rapid urease test gives an accuracy of 96%, with positive and negative predictive values of 95% and 97%, respectively. These results were highly reproducible with a Kappa test (P value<0.001). Cost of histology or rapid urease test with gastroscopy was 110 USD or 95 USD respectively while the cost of UBT was 15 USD. Microdose 14C UBT was comparable to histology and rapid urease test. 14C UBT is an economical, self sufficient and suitable test to diagnose active H pylori infection in less developed countries.

Investigation of Helicobacter pylori in the Middle Ear of the Patients with Chronic Otitis Media by CLO Test and 14C Urea Breath Test

The aim of this study was to investigate the presence of Helicobacter pylori by CLO test in the middle ear of the patients with chronic otitis media. We also investigated the relationship between H. pylori in the stomach and in the middle ear by 14C urea breath test (14C UBT) for the possible source of this bacterium. A prospective controlled clinical study. Tissue samples were obtained from the middle ear mucosa of 41 patients undergoing ear surgery for chronic suppurative otitis media and placed in the CLO test kit. C UBT was performed in 24 patients and 20 normal subjects. The CLO test results were positive in 22 patients (53.6%). Results of 14C UBT that was performed in 24 patients were positive in 19 patients (79.1%) and were positive in 6 control subjects (30%). Fifty-three percent of the middle ear mucosae obtained from 41 patients with chronic otitis media were shown to be positive for H. pylori, and although our results suggest that the source of this bacterium is the stomach, further clinical studies are needed.

Is the Remarkable Contradiction between Histology and 14C Urea Breath Test in the Detection of Helicobacter pylori due to False-negative Histology or False-positive 14C Urea Breath Test?

We assessed the diagnostic value of the 14C urea breath test (UBT) in the detection of Helicobacter pylori compared with histology and the rapid urease test (RUT). The study included 68 patients (22 men and 46 women) with dyspeptic symptoms. H. pylori status was evaluated by 14C UBT, RUT and histology. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were determined for 14C UBT and for RUT. Histology revealed dense yeast-like micro-organisms in the biopsy specimens in all patients with false-positive results by 14C UBT (n = 8), a significantly higher proportion than in patients with negative 14C UBT (five of 31). The low specificity of the H. pylori 14C UBT should not be neglected by accepting histology results as false-negative. Gastric mucosal colonization by yeast-like micro-organisms with urease activity can account for the high frequency of false-positive results for 14C UBT.

Breath Ammonia Testing for Diagnosis of Hepatic Encephalopathy

Measurement of arterial ammonia has been used as a diagnostic test for hepatic encephalopathy, but obtaining an arterial specimen is an invasive procedure. The aim of this study was to evaluate the ability of a minimally invasive, highly sensitive optical sensing device to detect ammonia in the breath of patients with end-stage liver disease and to evaluate the correlation of breath ammonia levels, arterial ammonia levels, and psychometric testing. Fifteen subjects with liver cirrhosis and clinical evidence of hepatic encephalopathy underwent mini-mental status examination, number connection test, focused neurological examination, and arterial ammonia testing. On the same day, breath ammonia testing was performed using an apparatus that consists of a sensor (a thin membrane embedded with a pH-sensitive dye) attached to a fiberoptic apparatus that detects optical absorption. Helicobacter pylori testing was performed using the 14C urea breath test. A positive correlation was found between arterial ammonia level and time to complete the number connection test (r = 0.31, P = 0.03). However, a negative correlation was found between breath ammonia level and number connection testing (r = -0.55, P = 0.03). Furthermore, no correlation was found between breath and arterial ammonia levels (r = -0.005, P = 0.98). There is a significant correlation between the trailmaking test and arterial ammonia levels in patients with cirrhosis. However, no correlation was found between breath and arterial ammonia levels using the fiberoptic ammonia sensor apparatus in this small study.

Efficacy and Tolerability of Rifampicin-Based Rescue Therapy for Helicobacter Pylori Eradication Failure in Peptic Ulcer Disease

In vitro activity of rifampicin has been shown against H. pylori. It has also been reported that the prevalence of H. pylori is low in patients with tuberculosis treated with rifampicin. Clinical trials are required to establish the efficacy of rifampicin as a salvage therapy for eradication of H. pylori. We aimed to evaluate the efficacy of rifampicin-based salvage therapy for eradication of H. pylori in patients with peptic ulcer disease. Twenty-eight patients with peptic ulcer disease who either had failed eradication of H. pylori or had a recurrence of H. pylori following successful eradication were included in the prospective study. The inclusion criteria included one or more failed attempts at eradication and presence of H. pylori infection as evidenced by positivity of at least two of three tests: rapid urease test (RUT), 14C urea breath test (UBT), and histology. The subjects were treated with a 10-day regimen consisting of rifampicin, 450 mg od, tetracycline, 1 g bd, and esomeprazole, 40 mg bd. Four weeks after completion of therapy, H. pylori status was assessed by RUT, 14C, UBT, and histology. Liver function tests were done before and at the end of therapy. The study subjects included 25 males and 3 females with a mean age of 33.7+/-8.92 years (range: 22-65 years). The median duration of symptoms was 42 months, with a range of 1-180 months. The median number of eradication attempts was two, with one prior attempt in 6 (21.4%), two attempts in 19 (67.9%), and three attempts in 3 (10.7%) patients. Successful H. pylori eradication as defined by concomitant negativity of RUT, UBT, and histology with special stains was achieved in 32.1% (9/28) of patients by intention-to-treat and 33.3% (9/27) of patients by per-protocol analysis. This pilot study suggests that rifampicin-based regimes have no role as salvage eradication therapy in refractory cases of H. pylori infection with peptic ulcer disease.

¿Es fiable el test del aliento para el diagnóstico de infección por Helicobacter pylori en atención primaria?

To evaluate the reliability of the breath test urea 13C in the primary care for the diagnosis of Helicobacter pylori (Hp) infection. Descriptive, prospective and multicentric.Location. Urban area belonging to the Health Center Actur Sur of Zaragoza with participation of Miguel Servet Hospital. 87 patients with clinical diagnosis of functional dispepsia. In all of them was made a breath test with 13C urea as well as a gastroscopy with taking of samples for histology and ureasa fast test. Age, sex and the presence of positivity or negativity of infection by Hp were valued in the histology, ureasa test and in the breath test, considering the histology and the ureasa test like gold tests for this measurement, reason why it was demanded that the positive or outside negative result in both considering it nonambiguous. Two cases were excluded by ambiguous results. The 77.6% (66/85) were positive by histology and ureasa test, and these, 92.4% (61/66) were positives to the breath test. The sensitivity of this test was 92% and the specificity 100%. The breath test in primary care has a high value diagnosis of Hp infection, being able to avoid, in some cases, another invasives techniques like gastroscopy.

No radiation protection reasons for restrictions on 14C urea breath tests in children.

Traditional (14)C urea breath tests are normally not used for younger children because the radiation exposure is unknown. High sensitivity accelerator mass spectrometry and an ultra-low amount (440 Bq) of (14)C urea were therefore used both to diagnose Helicobacter pylori (HP) infection in seven children, aged 3-6 years, and to make radiation dose estimates. The activity used was 125 times lower than the amount normally used for older children and 250 times lower than that used for adults. Results were compared with previously reported biokinetic and dosimetric data for adults and older children aged 7-14 years. (14)C activity concentrations in urine and exhaled air per unit administered activity for younger children (3-6 years) correspond well with those for older children (7-14 years). For a child aged 3-6 years who is HP negative, the urinary bladder wall receives the highest absorbed dose, 0.3 mGy MBq(-1). The effective dose is 0.1 mSv MBq(-1) for the 3-year-old child and 0.07 mSv MBq(-1) for the 6-year-old child. For two children, the 10 min and 20 min post-(14)C administration samples of exhaled air showed a significantly higher amount of (14)C activity than for the rest of the children, that is 6% and 19% of administered activity exhaled per hour compared with 0.3-0.9% (mean 0.5%) of administered activity exhaled per hour indicating that these two children that is were HP positive. For a 3-year-old HP positive child, absorbed dose to the urinary bladder wall was 0.3 mGy MBq(-1) and effective dose per unit of administered activity was 0.4 mSv MBq(-1). Using 55 kBq, which is a normal amount for older children when liquid scintillation counters are used for measurement, the effective dose will be approximately 6 micro Sv to a 3-year-old HP negative child and 20 microSv to a HP positive child. Thus there is no reason for restrictions on performing a normal (14)C urea breath test, even on young children.

Effect of Helicobacter pylori infection on fibrinogen level in elderly patients with ischaemic heart disease

Background — Fibrinogen is an important risk factor for ischaemic heart disease (IHD)1 and an elevated fibrinogen level has been reported in younger patients infected with Helicobacter pylori (H pylori) infection2,3. However, the effect of Helicobacter pylori infection on fibrinogen level in elderly population with IHD is not known. Also in particular the effect on fibrinogen with eradication of Helicobacter pylori has not been previously reported. The aim of this study was to investigate the influence of H pylori on fibrinogen levels in elderly patients with IHD and to assess the effect of eradication therapy on fibrinogen levels.Patients and methods — Forty patients over the age of 65 years presenting with symptomatic IHD and an age-matched control group of 21 patients were studied.The 14-C urea breath test was used for detecting H pylori infection. Patients found to be H pylori positive were treated with omeprazole 40 mg daily and amoxicillin 500 mg three times daily for 14 days. Fibrinogen concentration was measured at the beginning of treatment and repeated at 4 weeks after completion of treatment along with the urea breath test in those tested positive for H pylori and fibrinogen level was repeated at 6 weeks in the H pylori negative patients.Results — The prevalence of H pylori infection was 19/40 (47.5%) in the IHD group and 9/21 (42.8%) in the control group. The median serum fibrinogen level was 4.34 g/l (3.73-6.04 i.q. range) in H Pylori positive patients and 4.86 g/l (3.58-6.11 i.q. range) in H Pylori negative patients in both the IHD and age-matched control group, with no significant difference between the two groups, p=0.78 (Mann-Whitney test). In the IHD group 27/40 (67.5%) had a fibrinogen level > 4.0 g/l compared to 11/21 (52.3%) in the control group.The median fibrinogen level decreased significantly from 5.75g/l (i.q. range 4.39-6.71) to 4.41 g/l (i.q. range 3.80-6.06) after eradication treatment of H pylori in patients with raised fibrinogen levels (p < 0.01).Conclusion — The presence of H Pylori infection did not correlate with the presence of IHD, and the fibrinogen level was not raised in the IHD group.However, in elderly patients with H pylori infection, eradication therapy lowered fibrinogen levels in those with elevated (> 4.0 g/l) fibrinogen level.

Analysis on the causes for refractory GERD.

To analyze the causes of failure in conventional treatment to refractory gastroesophageal reflux diseases (GERD) patients, 16 refractory GERD patients (group R) and 16 cases of GERD primarily diagnosed (group P) were studied. Endoscopy, pathologic examination and 14C urea breath test were conducted in every patient. 24 h ambulatory pH and bilirubin monitoring were performed with Digitrapper MK III and Synetics Bilitec 2000. It was found that esophagitis in group R was more severe than in group P. The rate of Helicobacter pylori infection in group R was significantly lower than in group P. Fraction time pH below 4.00 was not longer while the bile reflux represented by fraction time abs above 0.14 was greater for patients in the group R as compared with those in the group P. The mixed refluxes and pure bile refluxes between the two groups had significant difference. The reflux episodes in the group R mainly occurred during nights. These results indicated that severe esophagitis, especially Barrett's esophagus with complications makes it difficult to control GERD. Severe duodenogastroesophageal refluxes (DGER) are often accompanied by refractory GERD. Mixed refluxes aggravate the esophageal injuries. Pure bile refluxes and nocturnal refluxes may cause failure of administration of proton pump inhibitors (PPI) in the morning. Helicobacter pylori infection and acid refluxes may not be the direct cause of refractoriness. Individual refractory GERD patient without abnormal results on pH or bile reflux recently should be diagnosed again.

Approaching Helicobacter pylori infection in children: Level I evidence at last and a word of caution

Approaching Helicobacter pylori infection in children: Level I evidence at last and a word of caution

Role ofHelicobacter pylori in cirrhotic patients with dyspepsia: A13C-urea breath test study

The role of Helicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease and H. pylori as determined by the (13C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%; H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in the H. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence of H. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease and H. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident between H. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.

Gastro-oesophageal reflux and duodenogastric reflux before and after eradication in Helicobacter pylori gastritis.

Helicobacter pylori and duodenogastric reflux (DGR) are both associated with chronic gastritis, peptic ulcer and gastric cancer. The nature of their interrelationship remains unclear. H. pylori eradication has also been reported to result in new or worsening acid gastro-oesophageal reflux (GOR). The aim of this study was to investigate the relationship between GOR, DGR and H. pylori infection. 25 patients with H. pylori gastritis underwent ambulatory 24-hour oesophageal and gastric pHmetry and gastric bilirubin monitoring before and 12 weeks after H. pylori eradication, confirmed by 14C urea breath testing (UBT). Ten healthy subjects served as a control group. There were no differences between patient and control groups for gastric alkaline exposure or gastric bilirubin exposure (P> 0.25 in all categories). Oesophageal acid reflux was higher in the study group (P< 0.02). No differences were detected in oesophageal acid reflux, gastric alkaline exposure, or gastric bilirubin exposure (P = 0.35, 0.18 and 0.11, respectively) before and after eradication. Acid GOR is not increased by H. pylori eradication. DGR in patients with H. pylori gastritis is similar to that in healthy, non-infected subjects. H. pylori eradication produces no change in GOR or DGR. In patients with chronic gastritis, H. pylori infection and DGR appear to be independent of each other.

PROFILE OF PEPTIC ULCER DISEASE IN THE ELDERLY

BackgroundPeptic ulcer disease has protean manifestations in various age groupsAimTo compare the clinical presentation and outcome of peptic ulcer disease in the elderly ( &gt;60 year) with age group less than 60 years.MethodsThis was a single center prospective study. The study subjects comprised of patients of peptic ulcer disease divided into 2 groups: ,&lt;60 year and &gt; 60 year. A total of 40 patient of endoscopically proven peptic ulcer were included with 20 patient in each age group. Detection of Helicobacter pylori was done by C14 urea breath test (UBT) and rapid urease test (RUT). Eradication therapy for Hp was given to patients who were either RUT or UBT positive. At the end of 6 weeks after completion of eradication regime endoscopy was repeated to look for ulcer healing and Hp eradication. A repeat endoscopy at 6 months was done for checking recurrence of ulcer or Hp.ResultsConclusionsThere is no increases prevalence of gastric ulcer in the elderly. Ina elderly, peptic ulcer disease presents more often with bleeding. There are no significant differences in eradication and recurrence rates of H. pylori in elderly as compared to the younger age group.

Effect of cholecystectomy on gastroesophageal and duodenogastric reflux.

The majority of patients experience resolution of their symptoms after cholecystectomy, but a minority either find their symptoms unchanged or complain of new upper GI symptoms. It has been suggested that the effect of cholecystectomy on upper GI motility, sphincter function, or bile delivery may account for these postoperative symptoms. We aimed to determine whether cholecystectomy affects gastroesophageal reflux or duodenogastric reflux by using 24-h ambulatory pH and gastric bilirubin monitoring before and after surgery. Seventeen symptomatic patients with gallstones underwent 24-h ambulatory esophageal and gastric pH-metry and gastric bilirubin monitoring. Helicobacter pylori status was ascertained in all patients by 14C urea breath test and serology. Combined pH and bilirubin monitoring was repeated 3 months after cholecystectomy. Eleven healthy subjects served as a control group. Three (17%) patients complained of persistent or new symptoms after surgery, whereas 14 (83%) patients were asymptomatic. Two patients (12%) underwent open cholecystectomy, and (88%) had the operation performed laparoscopically. No significant differences were detected in esophageal acid exposure (pH < 4), gastric alkaline shift (pH > 4), or gastric bilirubin exposure (absorbance > 0.14) after surgery. Three (17%) patients tested positive for Helicobacter pylori; the presence of infection did not appear to affect pre- or postoperative values. Cholecystectomy does not result in increased bile reflux into the stomach or increased gastroesophageal acid reflux. Those patients who had increased postoperative duodenogastric reflux were entirely asymptomatic. The symptoms of postcholecystectomy syndrome are unlikely to be related to increased duodenogastric reflux after surgery.

Effect of cholecystectomy on gastroesophageal and duodenogastric reflux

OBJECTIVE: The majority of patients experience resolution of their symptoms after cholecystectomy, but a minority either find their symptoms unchanged or complain of new upper GI symptoms. It has been suggested that the effect of cholecystectomy on upper GI motility, sphincter function, or bile delivery may account for these postoperative symptoms. We aimed to determine whether cholecystectomy affects gastroesophageal reflux or duodenogastric reflux by using 24-h ambulatory pH and gastric bilirubin monitoring before and after surgery. METHODS: Seventeen symptomatic patients with gallstones underwent 24-h ambulatory esophageal and gastric pH-metry and gastric bilirubin monitoring. Helicobacter pylori status was ascertained in all patients by 14C urea breath test and serology. Combined pH and bilirubin monitoring was repeated 3 months after cholecystectomy. Eleven healthy subjects served as a control group. RESULTS: Three (17%) patients complained of persistent or new symptoms after surgery, whereas 14 (83%) patients were asymptomatic. Two patients (12%) underwent open cholecystectomy, and (88%) had the operation performed laparoscopically. No significant differences were detected in esophageal acid exposure (pH < 4), gastric alkaline shift (pH > 4), or gastric bilirubin exposure (absorbance > 0.14) after surgery. Three (17%) patients tested positive for Helicobacter pylori; the presence of infection did not appear to affect pre- or postoperative values. CONCLUSIONS: Cholecystectomy does not result in increased bile reflux into the stomach or increased gastroesophageal acid reflux. Those patients who had increased postoperative duodenogastric reflux were entirely asymptomatic. The symptoms of postcholecystectomy syndrome are unlikely to be related to increased duodenogastric reflux after surgery.

Serologic evaluation of antibodies to H. pylori versus the C14 urea breath test in patients followed through two years posttreatment

Serologic evaluation of antibodies to H. pylori versus the C14 urea breath test in patients followed through two years posttreatment

Serologic evaluation of antibodies to H. pylori versus the C14 urea breath test in patients followed through two years posttreatment

Serologic evaluation of antibodies to H. pylori versus the C14 urea breath test in patients followed through two years posttreatment

A BLOOD-PROSTATE BARRIER RESTRICTS CELL AND MOLECULAR MOVEMENT ACROSS THE RAT VENTRAL PROSTATE EPITHELIUM

Blood-epithelial barriers have been described in the testis and epididymis, but the possibility of such barriers in other regions of the male genitourinary tract has received little investigation. The purpose of this study was to use in vivo micro-puncture to determine if the blood-epithelial barrier exists in the rat ventral prostate. In addition, using a model of prostatic inflammation, we sought to examine the effect of inflammation on the passage of blood borne molecules and leukocytes into the prostatic ductal lumen. Adult Sprague-Dawley rats were divided into two groups, control and 24-hour lipopolysaccharide (LPS)-induced inflammation. Both groups were subjected to vascular infusion of radiolabeled 3H dextran, 14C urea, and 3H water. Contemporaneous in vivo micropuncture sampling of prostatic ductal fluid (DF) and arterial blood occurred at multiple time points over 120 minutes. Transepithelial movement of radiolabeled compounds at each sampling time point was quantified by the expression of DF isotope concentrations as a percentage of serum isotope concentrations at that time point. Histology of representative specimens of control and inflamed prostates was used to confirm the inflammatory response and to examine for the presence of leukocytes into the ductal lumen. The transepithelial movement of radiolabeled compounds from blood to prostatic lumen varied in direct relationship to the compound's molecular weight. 3H-water (MW = 18) movement into the ductal lumina was relatively rapid plateauing at 70-80% of serum values. 14C urea (MW = 60) achieved intermediate penetration into ductal fluid (50-60% of serum values) and 3H dextran (MW = 2 x 106) was essentially excluded from entry (<2% of serum). These results were not altered by LPS-induced inflammation. Histology revealed a diffuse leukocyte infiltrate in the inflamed prostatic interstitium, but penetration of inflammatory cells into the ductal lumen was very restricted. Our findings demonstrate a blood-prostate barrier in the rat ventral prostate with characteristics similar to the blood-testis barrier. This blood-prostate barrier is not affected by LPS-induced acute inflammation. Further, this persistent barrier apparently restricts the passage of leukocytes into prostate DF even in the presence of pronounced interstitial inflammation. This observation may help to explain the observation that expressed prostatic secretions in human males are often free of leukocytes in clinical prostatitis.

34. The microdose rapid 14C urea breath test compares well with the original rapid 14 breath test

s: Abstracts of the 30th Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine