Breath Test Research Articles

Blood alcohol concentration in the clinical laboratory: a narrative review of the preanalytical phase in diagnostic and forensic testing.

The analysis of blood alcohol concentration (BAC), a pivotal toxicological test, concerns acute alcohol intoxication (AAI) and driving under the influence (DUI). As such, BAC presents an organizational challenge for clinical laboratories, with unique complexities due to the need for forensic defensibility as part of the diagnostic process. Unfortunately, a significant number of scientific investigations dealing with the subject present discrepancies that make it difficult to identify optimal practices in sample collection, transportation, handling, and preparation. This review provides a systematic analysis of the preanalytical phase of BAC that aims to identify and explain the chemical, physiological, and pharmacological mechanisms underlying controllable operational factors. Nevertheless, it seeks evidence for the necessity to separate preanalytical processes for diagnostic and forensic BAC testing. In this regard, the main finding of this review is that no literature evidence supports the necessity to differentiate preanalytical procedures for AAI and DUI, except for the traceability throughout the chain of custody. In fact, adhering to correct preanalytical procedures provided by official bodies such as European federation of clinical chemistry and laboratory medicine for routine phlebotomy ensures both diagnostic accuracy and forensic defensibility of BAC. This is shown to depend on the capability of modern pre-evacuated sterile collection tubes to control major factors influencing BAC, namely non-enzymatic oxidation and microbial contamination. While certain restrictions become obsolete with such devices, as the use of sodium fluoride (NaF) for specific preservation of forensic BAC, this review reinforces the recommendation to use non-alcoholic disinfectants as a means to achieve "error-proof" procedures in challenging operational environments like the emergency department.

Clearance tests as a diagnosis method of hepatobiliary system pathologies in animals

In present-day conditions of industrial agriculture, the animal's body works at the limit of its capabilities, which leads to degenerative diseases of various organs and systems. The development of ergonomic ways of modern diagnosis of these pathologies at the early stages contributes to the maintenance of quantitative and qualitative indices of productivity of animals and to the extension of the time of their economic use. The liver with a great number of functions performed is subjected to the highest load. The aim of the article is to review the available clearance tests in order to diagnose the pathology of the hepatobiliary system of animals at the early stage, considering advantages and disadvantages of the tests. As the result of the search of themed issues in various bibliographic databases there have been selected 45 mostly cited scientific articles. The article reviews such clearance tests as indocyanine green clearance test, aminopyrine breath test, sorbitol elimination test, galactose elimination test, phenylalanine breath test, and hepatobiliary scintigraphy method. Functional tests allow not only diagnosing and differentiating hepatopathologies, but also visualizing their course and liver recovery. Unlike laboratory tests, clearance tests make it possible to evaluate the work of the liver in dynamics. The disadvantages of clearance tests are lack of information for their wide use and frequency of particular differences in elimination of specific substances. To reduce the proportion of existing shortcomings, it is possible to combine clearance tests with other laboratory methods for diagnosing hepatopathy in animals.

Dynamics of the prevalence of <i>Helicobacter pylori</i> infection from 2015 to 2023

BACKGROUND: The global prevalence of Helicobacter pylori infection has decreased from 58.2% (1980–1990) to 43.1% (2011–2022). To develop clinical recommendations for prevention diseases associated with Helicobacter pylori, it is important to assess changes in Helicobacter pylori infection in the world and in the Russian Federation, in particular.
 AIM: To assess the dynamics of Helicobacter pylori infection among patients in St. Petersburg, who undergone 13С-urease breath test in the period from 2015 to 2023.
 MATERIALS AND METHODS: All the patients have been included in the descriptive study to conduct 13C-urease breath test. If the Delta Over Baseline was less than 2.5‰, the test was considered negative. The value of this indicator of more than 2.5‰ indicated infection with Helicobacter pylori. The database for subsequent statistical analysis included age, gender, the facts of prior eradicative therapy, test results, including degree of infection.
 RESULTS: Helicobacter pylori was detected in 32.7% (16,642; 95% confidence interval 32.3–33.1%) of the patients. Of the 50,884 study participants, 83.6% (42,543; 95% confidence interval 83.3–83.9%) of the patients had not received eradication therapy in the past (primary “naive” patients), 16.4% (8341; 95% confidence interval 16.1–16.7%) had undergone eradication therapy in the past therapy (treated “recurrent” patients). The average infection rate among primary patients was 36.1% (15,358; 95% confidence interval 35.6–36.6%), among recurrent patients — 15.4% (1284; 95% confidence interval 14.6–16.2%). From 2015 to 2017, a decrease in Helicobacter pylori infection was detected in “naive” and “recurrent” patients in all the groups by 14.8 and 21.1%, respectively, and from 2020 to 2023 — by 3.6 and 6.2%, respectively. The majority of both primary and recurrent patients showed a very high (IV) degree of infection — 73.0 and 66.5%, respectively.
 CONCLUSIONS: The study demonstrated significant reduction of Helicobacter pylori infection from 2015 to 2017 indicating that information from doctors about the importance of diagnosing and treating Helicobacter pylori infection is a priority task. The new coronavirus infection also had an impact on the incidence of the infection; however, it is still unclear what the negative consequences of the active use of antibacterial agents in patients with COVID-19 are, first of all, potential impact on Helicobacter pylori resistance to key antibacterial drugs.

Hydrogen and methane breath testing for abdominal bloating of small intestinal origin

Abdominal bloating with or without excessive gas production and with or without abdominal distention is common, very bothersome for patients, and is poorly understood. Bloating can be associated with gastrointestinal disorders, nutrient malabsorption, and systemic illnesses. The origin of abdominal bloating is often unclear, though it is usually associated with food intake and bowel motility dysfunction. Often, food allergies, food intolerance, or food poisoning are considered by the patient or physician as potential causes for bloating. A common concern in the patient’s mind is that healthcare professionals will dismiss or misdiagnose their complaint. The limited understanding of the pathophysiology of bloating leads to current empirical management, and bloating is often characterized as a “functional” disorder. Bloating carries a heavy clinical, psychological, and economic burden. Proper diagnosis will provide the patient with peace of mind and lead to effective treatment. This review focuses on the mechanisms and management of abdominal bloating associated with different small intestinal disorders identified by non-invasive hydrogen and methane breath tests.

Comprehensive, long-term evaluation of pancreatic exocrine insufficiency after pancreatoduodenectomy

AimsTreatment of pancreatic exocrine insufficiency (PEI) following pancreatoduodenectomy (PD) improves quality of life, clinical outcomes, and survival. However, diagnosing PEI following PD is challenging owing to the difficulties with current tests and often non-specific symptoms. This work aims to quantify the true rate of long-term PEI in patients following a PD. MethodsPatients underwent a PEI screen approximately one to two years following PD for oncologic indication, including the 13C Mixed triglyceride breath test (13CMTGT), faecal elastase 1 (FE-1) and the PEI Questionnaire (PEI-Q). Four reviewers with expertise in PEI reviewed the results blinded to other decisions to classify PEI status; disagreements were resolved on consensus. Results26 patients were recruited. Of those with valid test results, these were indicative of PEI based on pre-specified thresholds for 60 % (15/25) for the 13CMTGT, 82 % (18/22) for FE-1, and 88 % (22/25) for the PEI-Q. After discussion between reviewers, the consensus PEI prevalence was 81 % (95 % CI: 61–93 %; 21/26), with 50 % (N = 13) classified as having severe, 23 % (N = 6) moderate, and 8 % (N = 2) mild PEI. DiscussionSince no ideal test exists for PEI, this collation of diagnostic modalities and blinded expert review was designed to ascertain the true rate of long-term PEI following PD. This required our cohort to survive a year, travel to hospital, and undergo a period of starvation and PERT hold, and therefore there is likely to be recruitment bias towards fitter, younger patients with less aggressive pathology. Despite this, over 80 % were deemed to have PEI, with over 90 % of these being considered moderate or severe.

A population-based study of Helicobacter pylori: Does asymptomatic infection mean no gastroscopic lesions?

We determined the common clinical characteristics of patients infected with Helicobacter pylori (H. pylori) and investigated the relationship between H. pylori infection, and clinical symptoms, and gastroscopic manifestations. Our focus was specifically on the clinical manifestations in asymptomatic patients. We obtained the physical examination data of patients who underwent the 14C urea breath test between January 2018 and December 2020 at our Hospital. Basic demographic data, questionnaire data on clinical symptoms, and clinical examination data of the patients were also collected, and the correlation analysis was performed. A total of 2863 participants were included in the study. The overall H. pylori infection rate was 26.30%. The clinical symptoms between H. pylori-positive patients and H. pylori-negative patients did not differ significantly (P > .05). However, H. pylori-positive patients exhibited more severe gastroscopic manifestations (P < .001). The 14C urea breath test disintegrations per minute (DPM) values in H. pylori-positive patients correlated with their serum pepsinogen and gastrin-17 levels. With an increase in the DPM value, more combinations of clinical symptoms appeared in the patients. Among H. pylori-positive patients, DPM levels in asymptomatic patients were lower than those in symptomatic patients (P < .001). However, gastroscopic manifestations did not vary significantly between asymptomatic and symptomatic patients (P > .05). Patients infected with H. pylori showed no specific gastrointestinal symptoms. Patients with asymptomatic infection showed lower DPM levels, but their gastroscopic manifestations were similar to those of patients with symptomatic infection, and their lesions were more severe than H. pylori-negative people.

Utilising Pancreatic Exocrine Insufficiency in the Detection of Resectable Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed late, leading to a high mortality rate. Early detection facilitates better treatment options. The aim of this UK-based case-control study was to determine whether two validated tests for pancreatic exocrine insufficiency (PEI), namely, the 13C-mixed triglyceride breath test (13C-MTGBT) and a faecal elastase (FE-1) test, can discriminate between patients with resectable PDAC versus healthy volunteers (HVs) along with a comparison group with chronic pancreatitis (CP). Discrimination between disease states and HVs was tested with receiver operator characteristic (ROC) curves. In total, 59 participants (23 PDAC (16 men), 24 HVs (13 men) and 12 CP (10 men)) were recruited, with a similar age in each population, and a combined median (IQR) age of 66 (57-71). The areas under the ROC curve for discriminating between PDAC and HVs were 0.83 (95% CI: 0.70-0.96) for the 13C-MTGBT, and 0.85 (95% CI: 0.75-0.95) for the FE-1 test. These were similar to CP vs. HV. In conclusion, PEI occurs in resectable PDAC to a similar extent as in CP; further large-scale, prospective studies using these tests in the primary care setting on high-risk groups are warranted.

Stable COPD Picture through Exhaled Breath Condensate, Questionnaires and Tests. A Proof of Concept Study

Background: Changes in lung structures persist in stable Chronic Obstructive Pulmonary Disease (COPD), but their correlation with the clinical picture remains unclear. The purpose of this study was to assess the stable COPD picture via the relationship between exhaled breath condensate (EBC) particle concentration and the Saint George Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and six-minute walking test (6 MWT). Methods: 12 stable COPD and 12 healthy subjects participated in the study. The EBC was collected with Rtube and analyzed using the Accusizer FxNano. Particle concentration was measured and correlated with the findings of the tools used to assess the health status and functional profile of COPD. The results’ analysis was performed with the Spearman’s test and the Mann-Whitney U - test. Results: The COPD group presented a worse picture of health status and functional profile compared to the healthy group. Correlations were observed between components of the SGRQ and CAT. The two groups presented similar levels of EBC particle concentrations, but the number of small particles was higher in COPD subjects. A correlation of the EBC particle concentration with the activity and total score of the SGRQ was only observed in the healthy group. Conclusion: The total particle number was similar in the COPD and healthy groups. A few correlations between the EBC particles and tools used were also observed. The use of EBC particle concentration to monitor COPD status cannot be claimed with confidence because of the small sample size. Further research is necessary, particularly in large-scale groups.

Validation of the PyloPlus Urea Breath Test System in pediatric patients.

For the diagnosis and post-treatment monitoring of H. pylori infection, non-invasive testing methodologies improve patient comfort, particularly for children. Previously, only the BreathTek UBT had FDA approval for use in pediatric patients and required an adjustment calculation based on age, height, and weight of the patient. The purpose of this study was to evaluate the performance of the PyloPlus UBT assay in a pediatric population.

All-cause and cause-specific mortality among individuals imprisoned for driving under the influence of alcohol and drugs in Norway (2000–2016): a retrospective cohort study

AimsTo describe all-cause and cause-specific mortality and to investigate factors associated with mortality among individuals imprisoned for driving under the influence (DUI) of alcohol and psychoactive drugs in the Norwegian...

When Driving Under the Influence Leads to Manslaughter: Perceptions of Plea Bargains

Abstract The present study examined perceptions of driving under the influence (DUI) manslaughter cases that result in plea bargains. Participants (32 women, 23 men) read a vignette describing a DUI case in which the intoxicated driver hit and killed another person and were then asked to answer questions about their perceptions of the case. We used a within-participant design and manipulated the age of the victim, the type of plea bargain, and the location of the victim. Results showed that participants had less support for the plea bargain when the victim was 6 years old versus 40 years old and when the plea bargain involved probation versus jail time. Sentiment indirect effect analyses indicated that participants had more negative sentiment when the victim was a child and the sentence involved probation, leading to the reduction in support for the plea. The results are discussed in terms of procedural justice theory and the impact of public perceptions on the use of plea bargains.

Roadway Weather Challenges Illuminate Real‐World Driving Biomarkers of Dementia Risk

AbstractBackgroundCognitive decline is a leading early predictor of dementia risk and may be evident in real‐world (RW) digital data even before patients ever present to clinic. This study examined the feasibility of using video and digital sensor profiles of real world (RW) driving in adverse weather as a marker of dementia risk.Method70 older drivers (mean age = 75.6 years) without dementia participated in a RW driving study for 2, 3‐month periods, one year apart (Wang, et al. 2021) . Self‐reported demographics and neuropsychological tests relevant to dementia and driving were collected at study start. Drivers were classed as cognitively neurotypical (N = 33) or impaired (N = 44) based on normed neuropsychological scores. Sensors installed in each driver’s vehicle collected video, speed, and GPS data across 405,104 miles driven. GIS data categorized roadway type (residential, commercial, interstate). A computer vision model (99% accuracy) we developed classed roads as clear or poor (rain, snow). Bayesian mixed‐effect logistic regressions assessed driver speed limit compliance (vehicle speed‐posted speed limit) across driver class, roadway, and weather.ResultDrivers were 8.01 times more likely to speed on interstates (95% CI: 7.61‐8.61) than residential roads (15‐25 mph). Impaired drivers were 15% more likely to drive slower than neurotypical drivers on clear roadways (95% C: 1.0413‐1.2829). This pattern reversed in poor weather with impaired drivers driving faster than neurotypical (b = 0.74, 95% CI: 0.57‐0.94)ConclusionDigital biomarkers from RW data show promise to screen for early dementia risk, advancing research and innovative clinical trials to prevent dementia. Driving challenges, like poor weather, discriminate cognitive decline before dementia. Impaired drivers showed self‐restriction by driving slower on clear roads and reduced self‐restriction by driving faster in poor weather despite risk. Big data strategies, like computer vision, complement driver performance data to identify RW environmental risk, paving the road for the car as a medical diagnostic device.

Fine-Grained Intoxicated Gait Classification Using a Bilinear CNN.

Consuming excessive amounts of alcohol causes impaired mobility and judgment and driving accidents, resulting in more than 800 injuries and fatalities each day. Passive methods to detect intoxicated drivers beyond the safe driving limit can facilitate Just-In-Time alerts and reduce Driving Under the Influence (DUI) incidents. Popularly-owned smartphones are not only equipped with motion sensors (accelerometer and gyroscope) that can be employed for passively collecting gait (walk) data but also have the processing power to run computationally expensive machine learning models. In this paper, we advance the state-of-the-art by proposing a novel method that utilizes a Bi-linear Convolution Neural Network (BiCNN) for analyzing smartphone accelerometer and gyroscope data to determine whether a smartphone user is over the legal driving limit (0.08) from their gait. After segmenting the gait data into steps, we converted the smartphone motion sensor data to a Gramian Angular Field (GAF) image and then leveraged the BiCNN architecture for intoxication classification. Distinguishing GAF-encoded images of the gait of intoxicated vs. sober users is challenging as the differences between the classes (intoxicated vs. sober) are subtle, also known as a fine-grained image classification problem. The BiCNN neural network has previously produced state-of-the-art results on fine-grained image classification of natural images. To the best of our knowledge, our work is the first to innovatively utilize the BiCNN to classify GAF encoded images of smartphone gait data in order to detect intoxication. Prior work had explored using the BiCNN to classify natural images or explored other gait-related tasks but not intoxication Our complete intoxication classification pipeline consists of several important pre-processing steps carefully adapted to the BAC classification task, including step detection and segmentation, data normalization to account for inter-subject variability, data fusion, GAF image generation from time-series data, and a BiCNN classification model. In rigorous evaluation, our BiCNN model achieves an accuracy of 83.5%, outperforming the previous state-of-the-art and demonstrating the feasibility of our approach.

The Usage of Artificial Intelligence Algorithms in Preventing Drunk Driving

Drunk driving is a very widespread problem, causing many casualties and millions of dollars in insurance and damages per year. In 2020, despite the COVID19 pandemic greatly reducing road traffic, about 32 people died per day in the US alone from DUI (Driving under Influence)(nhtsa.gov). Existing solutions such as police testing drivers suspected to be under influence is simply impractical considering the number of possible intoxicated drivers. With more and more people gaining access to a vehicle, it is crucial that more effective strategies be developed to detect and combat drunk driving. The purpose of this study is to analyze whether Artificial Intelligence can be used to more effectively detect and prevent drunk driving and if a Machine Learning models like Logistic Regression and Decision Tree can be more accurate than a human police officer. To address this question, a dataset named drunkImagesWebp was used. Two machine learning algorithms, Logistic regression and decision tree were trained on this dataset with facial image data of intoxicated people to predict the sobriety of humans based on facial cues. After testing this model, it is clear that both Logistic regression and decision tree models can accurately test a driver for signs of intoxication with well over 90% accuracy compared to human-administered tests which only hit up to around 75% accuracy. By comparison, both Logistic regression and Decision tree algorithms detected intoxication with 96% accuracy. This shows the potential AI can have in creating an automated solution to detecting and ultimately preventing drunk driving.

소장내 세균 과증식 진단과 치료 7예

Small intestinal bacterial overgrowth is defined as the presence of the formation of abnormally large bacterial colonies in the small intestine. The common symptom of small intestinal bacterial overgrowth includes abdominal bloating, diarrhea, constipation, abdominal pain, and flatulence. Breath testing is generally recognized as a useful, non-invasive tool for diagnosing small intestinal bacterial overgrowth. Therefore, the author would like to introduce seven medical cases of diagnosis and treatment of small intestinal bacterial overgrowth using lactulose breath test.

Assessing the Efficacy of a Modified Triple Drug Regimen Supplemented with Mastic Gum in the Eradication of Helicobacter pylori Infection

Abstract Introduction/Objective Helicobacter pylori (H. pylori) is a bacterium that infects the stomach and small intestine. It is known to be the main cause of gastritis and peptic ulcers. The infection is common worldwide, with a prevalence rate of 50% in many countries. Eradication of H. pylori infection is crucial, as failure to do so can lead to serious complications such as gastric cancer. Treatment for H. pylori infection involves a combination of antibiotics, proton pump inhibitors (PPIs), and bismuth compounds. However, due to the emergence of antibiotic resistance, there is a need for alternative treatments. Methods/Case Report This study had been a randomized controlled trial involving 180 patients with H. pylori infection. The patients had been divided into two groups: Group A received the standard triple-drug regimen (clarithromycin, amoxicillin, and omeprazole), while Group B received the triple-drug regimen along with mastic gum. The treatment duration was 14 days for both groups. Baseline demographics and clinical characteristics had been collected for all patients. The presence of H. pylori infection had been confirmed by a urea breath test and fecal antigen test. Results (if a Case Study enter NA) This study has investigated the effects of mastic gum on H. pylori infection. In a randomized controlled trial of 180 H. pylori-positive patients, mastic gum was found to be effective in eradicating the bacteria in 83 of 90 patients (92.2%) who received the supplementation Group B received the triple-drug regimen along with mastic gum, compared to only 57 of 90 patients (63.3%) in the group A (p &amp;lt; 0.001). Thus, a randomized controlled trial of 90 patients with H. pylori infection found that combination therapy of mastic gum and a triple-drug regimen resulted in a significantly higher eradication rate (92.2%) compared to a triple-drug regimen only (63.3%). Conclusion The current study investigated the adding mastic gum to the standard triple-drug regimen can improve the eradication rate of H. pylori infection. This could potentially offer an alternative treatment option for patients with H. pylori infection, especially those with antibiotic resistance. Applying the mastic gum has approved its effectiveness, and it could reduce the reliance on antibiotics and minimize the risk of resistance development.

Helicobacter pylori Infection Status and Gastric Tumor Incidence According to the Year of Birth.

: The prevalence of Helicobacter pylori-naive status is increasing. Nonetheless, biennial gastroscopy is recommended for all Koreans aged 40 to 75 years. This study aimed to determine whether gastric cancer screening guidelines could be changed according to H. pylori infection status and year of birth. : Koreans who underwent serum assays and gastroscopy for gastric cancer screening between 2010 and 2016 were included if screening tests were followed up for ≥3 times. H. pylori infection was confirmed when invasive tests or 13C-urea breath tests were positive. In the case of negative test findings, eradication history, serologically detected atrophy, and intestinal metaplasia/atrophy were checked for past infection. If all were absent, H. pylori-naive status was confirmed. : Two-thousand and two (256 H. pylori-naive, 743 past-infected, and 1,003 infected) Koreans underwent screening tests for 95.5±28.4 months. The mean year of birth in the naive group (1969±7) differed from those of the past-infected (1957±10, p<0.001) and infected (1958±10, p<0.001) groups. H. pylori-naive status was correlated with recent year of birth (r=0.368, p<0.001). No gastric tumors were observed among the naive participants (p=0.007), whereas 23 adenomas, 18 adenocarcinomas, and two neuroendocrine tumors were detected in 1.9% (14/743) of past-infected and 2.5% (25/1,003) of infected participants, including four infected participants with metachronous tumors. : The prevalence of H. pylori-naive status is increasing in young Koreans, and gastric tumors are rare in this population. Hence, biennial gastroscopy could be waived after the confirmation of naive status.

Should We Screen All the Immune Thrombocytopenia Patients for Helicobacter Pylori Infection in High-Prevalence Countries?

Background: Immune thrombocytopenia (ITP) is an autoimmune disease mediated by anti-platelet autoantibodies. Helicobacter pylori ( H. pylori) may modulate the Fcγ-receptor balance of monocytes/macrophages in favor of activating Fcγ receptors, and its components may mimic the molecular makeup of platelet antigens. In Mexico, the percentage of seroprevalence is 66%. There is not enough evidence available to determine the impact of the screening and eradication of H. pylori in ITP patients in the context of a region with a high prevalence of this infection. Study design and methods: This retrospective cohort study included all adult patients older than 18 years, newly diagnosed with ITP in a reference center in Mexico City. We evaluated the frequency and impact of H. pylori screening and eradication in patients diagnosed between 2016 and 2023. The H. pylori screening was made by urea breath test. Response criteria were based on the 2019-American Society of Hematology guidelines. Results: After a median follow-up of 38 months (interquartile range (IQR) 16.7 - 58.2 months), 106 patients with ITP were identified, of whom 73 (69%) were women. Most of them (92.3%) required first line treatment, all with corticosteroids: 44.9% dexamethasone, 44.9% prednisone, and 10.2% methylprednisolone followed by prednisone. Only 3 patients (3%) received intravenous immune globulin. Overall response rate (ORR) was observed in 76% with complete response (CR) of 47%, and partial response (PR) of 29%. During follow-up, 28 patients (26.5%) developed chronic ITP. Screening for H. pylori was performed in 82 patients (77.5%): 35.8% at diagnosis, 21.9% at relapse and 19.8% at a different time point. A comparison was made between the patients who underwent H. pylori test at diagnosis (N=38) vs. those who didn't (N=67) and the only baseline difference was a younger age in patients untested: 38 vs. 44 years (p=0.026) (see Table 1). Only 2/38 patients tested for H. pylori at diagnosis had gastrointestinal symptoms and both were negative for H. pylori. All the patients with a positive result for H. pylori infection received treatment and in all the patients eradication was confirmed. There was no significant difference in responses to the first line treatment between patients with and without H. Pylori infection: CR 30.0% vs. 44.4%, PR 50.0% vs. 27.7% and non-response 20.0% vs. 27.7% (p=0.387). Patients who underwent an H. Pylori test at diagnosis and eradication treatment if positive, had a lower relapse rate: 88.4% vs. 62.1%, p=0.009 (OR 0.213; 95% CI 0.069-0.664). Median relapse free survival was higher in patients who were screened for H pylori at diagnosis vs. those who were not: 15 months (95% CI 2.1-27.9 months) vs. 5 months (95% CI 2.5-7.5 months), p=0.001) (see Figure 1). Conclusions: These results suggest that screening and eradication of H pylori since diagnosis can be associated with a lower risk of relapse and a higher relapse-free survival in the context of a country with a high-prevalence of H. pylori infection. We found no relation with the presence of H. pylori and the platelet count or gastrointestinal symptoms, so the screening should be considered regardless of these aspects. The impact of treating H. pylori on ITP-responses cannot be assessed because all the patients receive eradication treatment, but the strategy of screening and treating if positive is associated with lower relapse-rates.

FODMAP meal challenge test: a novel investigation to predict response to low-FODMAP diet in non-constipating irritable bowel syndrome.

Though a low-FODMAP diet improves 50% irritable bowel syndrome (IBS) patients, regional dietary variations, vegetarianism, and long-term nutritional consequences challenge its implementation. We aimed developing a FODMAP meal challenge test (FMCT). We prospectively studied whether (i) high- than low-FODMAP foods produce more breath H2 among IBS patients than controls; (ii) post-meal symptoms relate to breath H2 ; and (iii) novel FMCT predicts response to a low-FODMAP diet? Forty Rome III IBS and 20 healthy controls underwent an eight-hour H2 breath test following a low- (rice, brinjal, corn, and banana [450Kcal]) and a high-FODMAP meal (wheat, kidney bean, pulse, and card [450Kcal]). Breath H2 (every 15min) and symptoms following low- and high-FODMAP meals were recorded. IBS-symptom severity scores were recorded every month for 3-months on low-FODMAP diet. Forty Rome III IBS (19 Rome IV positive) were comparable to 20 controls in age and gender. IBS patients (n=39 excluding one H2 non-producer) and controls produced more breath H2 after high- (greater in IBS) than low-FODMAP meal. Post-meal symptoms were commoner in IBS (4/40 [10%] and 27/40 [67.5%] with low- and high-FODMAP, respectively [P<0.00001]; none in healthy). IBS patients developing post-high-FODMAP meal symptoms produced greater H2 (18PPM [IQR 10.5-23] vs 6 [0-7.2]; P<0.001). A positive FMCT (breath H2 >10PPM above basal with symptoms following high-FODMAP food) had sensitivity, specificity, and diagnostic accuracy of 78.6%, 66.6%, and 75.6%, respectively, to predict low-FODMAP diet response. The novel FMCT predicts response to a low-FODMAP diet in IBS.

Helicobacter pylori infection prevalence declined among an urban health check-up population in Chengdu, China: a longitudinal analysis of multiple cross-sectional studies.

The efficacy of updated health policy in improving the generalization of Helicobacter pylori screening and eradication in southwest China was assessed in a longitudinal analysis of multiple cross-sectional studies from an institution. In the periods 2009-2010, 2013-2014, and 2019-2021, 8,365, 16,914, and 18,281 urban observations from health check-ups at West China Hospital were analyzed, respectively. The 14C-urea or 13C-urea breath test was consistently used for H. pylori detection. The protocol has been reported elsewhere (PROSPERO Registration number: CRD42019120764). The overall prevalence of H. pylori dramatically decreased from 53.1% to 30.7% over the past decade (OR = 0.39, 95% CI 0.37-0.41), with a similar decline in all sex-specific and age-specific subgroups. The age-specific prevalence consistently increased before 40 years of age and always peaked at 50-59 years. Longitudinal clearance increased along with aging, and prevalence dropped to 22.6%, 25.1%, and 23.6% in the 40-49, 50-59, and 60-69 years initial age groups, respectively. The generalization of H. pylori screening and eradication could greatly contribute to the control of H. pylori infection among urban health check-up populations and lower gastric cancer incidence.