Pylori In Adults Research Articles

Efficacy and Safety of Postbiotic Contained Inactivated Lactobacillus reuteri ( Limosilactobacillus reuteri ) DSM 17648 as Adjuvant Therapy in the Eradication of Helicobacter pylori in Adults With Functional Dyspepsia: A Randomized Double-Blind Placebo-Controlled Trial.

Increasing the effectiveness of eradication therapy is an important task in gastroenterology. The aim of this study was to evaluate the efficacy and safety of postbiotic containing inactivated (nonviable) Limosilactobacillus (Lactobacillus)reuteri DSM 17648 (Pylopass) as adjuvant treatment of Helicobacter pylori eradication in patients with functional dyspepsia (FD). This randomized, double-blind, placebo-controlled, multicenter, parallel study included H. pylori -positive patients with FD. The postbiotic group received Pylopass 200 mg bid for 14 days in combination with eradication therapy (esomeprazole 20 mg bid + amoxicillin 1,000 mg bid + clarithromycin 500 mg bid for 14 days) and another 14 days after the completion of eradication therapy. The study was registered in the ISRCTN registry (ISRCTN20716052). Eradication efficiency was 96.7% for the postbiotic group vs 86.0% for the placebo group ( P = 0.039). Both groups showed significant improvements in quality of life and reduction of most gastrointestinal symptoms with no significant differences between groups. The overall number of digestive adverse effects in the postbiotic group was lower than in the placebo group. Serious adverse effects were not registered. The postbiotic containing inactivated L. reuteri DSM 17648 significantly improves the effectiveness of H. pylori eradication therapy in FD and decreases overall number of digestive adverse effects of this therapy.

Эпидемиология инфекции Helicobacter pylori в Российской Федерации с 1990 по 2023 г.: систематический обзор

H. pylori affects more than half of the world's population and is associated with chronic gastritis, which can progress to serious complications such as peptic ulcer disease, gastric cancer, and MALT lymphoma. Epidemiological studies allow for the assessment of the level and changes in the prevalence of H. pylori infection. This paper addresses the results of H. pylori prevalence studies conducted in the Russian Federation. The high prevalence of H. pylori in adults and children in the 1990s and its significant reduction in recent years are reported. The prevalence of infection in adults is greater than in children in all time intervals studied, which is probably associated with poorer sociohygienic conditions in childhood in previous generations. The results of epidemiological studies on the prevalence of H. pylori are heterogeneous and depend on the time of the study, the region, and diagnostic method. The prevalence of H. pylori infection as determined by the 13C urea breath test has been found to be lower than that observed in serological studies. This discrepancy is attributed to the greater specificity of the breath test in detecting current infection KEYWORDS: Helicobacter pylori, epidemiological study, prevalence of H. pylori, Helicobacter infection, Russian Federation. FOR CITATION: Bordin D.S., Kuznetsova E.S., Stauver E.E., Nikol'skaya K.A., Chebotareva M.V., Voynovan I.N., Neyasova N.A. Epidemiology of Helicobacter pylori infection in the Russian Federation from 1990 to 2023: a systematic review. Russian Medical Inquiry. 2024;8(5):260–267 (in Russ.). DOI: 10.32364/2587-6821-2024-8-5-3.

Two Cases of Acute Gastric Mucosal Lesions Due to Helicobacter pylori Infection Confirmed to be Transient Infection.

Two adult cases of acute gastric mucosal lesions (AGML) caused by Helicobacter pylori infection were confirmed by spontaneous eradication during the follow-up period. The clinical course of the initial infection by H. pylori in adults with AGML remains unclear, whether it is transient or progresses to a persistent infection. In these two reported cases, gastric biopsies at the time of the onset revealed the presence of H. pylori; however, serum H. pylori antibodies performed at the same time were negative. Retesting for H. pylori serum antibody, after six months in one and after two months in the other, was negative, confirming spontaneous eradication.

Risk factors of ABO types associated with Helicobacter pylori in adults

Risk factors of ABO types associated with Helicobacter pylori in adults

S3634 Menetrier Disease: A Case Report

Introduction: Menetrier disease is a rare form of protein-losing gastropathy that is characterized by enlarged mucosal folds in the proximal part of the stomach. Although it is generally self-limited in children, adult patients are at increased risk of malignancies, thromboembolic phenomenon, and gastric outlet obstruction. Considering the high risk of morbidity and mortality, prompt diagnosis and management are needed. We present a rare case of Menetrier disease, occurring in a postpartum female patient. Case Description/Methods: A 25-year-old female patient presented with nausea and abdominal cramping, diarrhea and weight loss of 9 kg five weeks after delivering her 3rd child. These symptoms were followed by anasarca. Her laboratory tests showed hypoalbuminemia of 1.5 g/dl, low total protein level of 3.4 g/dl, elevated urine protein-to-creatinine ratio of 0.8, and elevated random urine protein of 16 mg/dl with otherwise normal labs (e.g., complete blood count, comprehensive metabolic panel). An esophagogastroduodenoscopy revealed markedly diffuse thick folds in the gastric fundus, body and antrum (Figure A). Antral mucosa and antral-fundic transition zone mucosa showed foveolar hyperplasia with negative Helicobacter pylori and cytomegalovirus (CMV) staining (Figure B). She was treated with IV antiemetics, IV albumin and furosemide and started on a pureed, high-protein diet which resulted in a significant improvement in her symptoms. Discussion: Although the pathophysiology of Menetrier disease is unclear, it has been associated with CMV infection in children and H. Pylori in adults. One hypothesis contributes the etiopathogenesis to an overexpression of the transforming growth factor-alpha. It commonly presents in male adult patients with epigastric pain, fatigue, weight loss, edema or/and vomiting. The diagnosis can be made based on histopathology showing extreme foveolar hyperplasia and atrophic changes in glandular epithelium. Moreover, endoscopy or barium study showing markedly enlarged gastric rugae along with laboratory findings of lymphopenia and reduced globulin, albumin, alpha-1-antitrypsin, cholesterol, ceruloplasmin and fibrinogen levels are indicative of this disease. Supportive treatment involves high-protein diet, proton pump inhibitors, and replacement of micronutrients. Treatment of H. pylori, CMV, and medications like octreotide or cetuximab showed improvement in disease progression in some patients.Figure 1.: Marked enlarged gastric rugae on endoscopy (A) and foveolar hyperplasia on biopsy (B).

Gut-Homing CD4+ T Cells Are Associated with the Activity of Gastritis in HIV-Infected Adults.

Previous studies have shown that HIV-infected individuals were less susceptible to chronic gastritis and Helicobacter pylori infection. Th1 and Th17 cells are important components of the immune response to H. pylori in adults. We investigated the relative importance of Th1 versus Th17 responses for mucosal inflammation and protection. We conducted a prospective cross-sectional study to evaluate the relationship among the peripheral blood gut-homing CD4+ T cell subset, the severity of chronic H. pylori gastritis, and H. pylori amount in the gastric mucosa. Biopsy specimens were obtained at the time of gastroendoscopy, which was used for classification of histological gastritis by updated-Sydney system. Peripheral blood mononuclear cells were collected at the same point to determine the frequency of peripheral blood gut homing CD4+ T cells (CCR9+integrin β7+) and CD4+ memory T cells subsets by flow cytometry. H. pylori amount in the gastric mucosa was measured using 16S ribosomal RNA gene amplicon sequencing. Peripheral blood gut-homing CD4+ T cells were significantly higher in individuals with histological gastritis compared with those without chronic gastritis (median 16.8 cells/μL vs. 9.7 cells/μL; p = .0307). In particular, there were significant differences in gut-homing Th1 (median 1.3 cells/μL vs. 0.5 cells/μL; p = .0061) and nonconventional Th1 (median 0.4 cells/μL vs. 0.2 cells/μL; p = .0196). In addition, there was a significant positive correlation between H. pylori amount in the gastric mucosa measured using 16S ribosomal RNA gene amplicon sequencing and gut-homing Th1 subsets. Our findings suggested that gut Th1 may play a key role in the development of chronic gastritis in HIV-infected individuals.

The association between chronic periodontitis and oral Helicobacter pylori: A meta-analysis.

BackgroundEpidemiological studies have shown that gastrointestinal Helicobacter pylori (H. pylori) infection is the main cause of chronic gastritis, but the relation between oral H. pylori and chronic periodontitis (CP) remains uncertain. A meta-analysis of published papers was performed to elucidate the correlation between oral H. pylori and CP.MethodTo perform this meta-analysis, we searched papers published from 2000 to 2018 on PubMed, OVID, Springer Link, Chinese National Knowledge Infrastructure (CNKI) and Chinese Biology Medicine search engines. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the correlation between H. pylori and CP were estimated. Heterogeneity, publication bias and subgroup analyses were also conducted.ResultsA total of 918 papers on oral H. pylori and CP were collected, and 11 papers were in accordance with the inclusion criteria. Oral H. pylori was suggested to be correlated with CP. The results indicated that a H. pylori-positive state significantly increased the risk of CP 3.42 times (OR = 3.42; 95% CI = 2.71–4.31). A diagnostic test using polymerase chain reaction (PCR) showed a higher prevalence of H. pylori (OR = 3.70; 95% CI = 2.66–5.14) than did that using the rapid urease test (RUT) (OR = 3.13; 95% CI = 2.26–4.34).ConclusionsThis paper demonstrated that CP was potentially correlated with oral H. pylori in adults and that oral H. pylori may be a possible risk factor for CP.

Management of Helicobacter pylori in Piedmont, Italy.

Helicobacter pylori (H. pylori) is a Gram-negative bacterium, usually acquired during childhood, whose natural habitat is the gastric lumen. H. pylori is accepted as the most important cause of gastritis and peptic ulcer in humans. Nevertheless, its important role in the pathogenesis of gastric cancer as well as in several extra-gastroduodenal diseases has been confirmed. The aim of this work is to discuss, for the first time in a single article, all publications concerning H. pylori infection arising from Piedmont region, Italy, where in 1893 Giulio Bizzozero was the first who observed and described spiral organisms in the stomach of animal models. A systematic review of all publications on the management of H. pylori in adults in Piedmont, based on a PubMed and a Scopus research from 1965 to 2017 was performed. The discussed aspects are the epidemiology, the study on gastric and extragastric diseases related to H. pylori, the diagnostic methods, the treatment of H. pylori infection, and the possibility of reinfection. In conclusions, with almost 70 publications, Piedmont has proudly maintained the tradition of the father of the H. pylori.

The drug resistance and evolution of Helicobacter pylori in adults of mainland China

The drug resistance and evolution of Helicobacter pylori in adults of mainland China

Helicobacter pylori treatment in children: Defining a dose for rabeprazole as a part of a triple therapy regimen

The proton pump inhibitor, rabeprazole, has been studied in children for the treatment of gastroesophageal reflux disease (GERD). In adults, rabeprazole is indicated for Helicobacter pylori eradication in combination with amoxicillin and clarithromycin. Nonlinear mixed effects modeling was conducted to estimate pharmacokinetic (PK) parameters for rabeprazole and its thioether metabolite from 336 subjects, 35% of whom were children 1-11 years with GERD from phase I and III studies. A 2-compartment disposition model with a transit absorption model provided the best fit for rabeprazole PK. The steady-state area under the concentration-time curves given several candidate doses were simulated to identify a dose per each body weight group that is comparable to a 20 mg twice-daily dose in adults, which is the recommended dose for treatment of H. pylori in adults. Simulations provided the following recommended twice-daily weight-based doses for children ≥1 year and <16 years: 10 mg for 6-10 kg, 15 mg for 10-30 kg, and 20 mg for ≥30 kg.

Epidemiological Study on H. pylori in Cattle and Its Milk with Special Reference to its Zoonotic Importance

This study was carried out to investigate some epidemiological aspects on the occurrence of Helicobacter pylori in cattle, milk and humans at Dakahlia province, Egypt during the period from February 2014 to June 2015. A total of 304 samples including 117 rectal swabs (53 cows and 64 buffaloes) and 85 milk samples (36 cows and 49 buffaloes) sand 102 humans stools were collected and subjected to bacteriological examination by culturing on Columbia Blood Agar (CBA) and biochemically identified. The results showed that the overall occurrence of H. pylori were 21.7% in collected samples. The occurrence in cattle faeces was 18.8% (11.9% in cows and 6.9% in buffaloes). However, the isolation rate from cattle milk was 28.2% (10.5% in cows and 17.7% in buffaloes). Moreover, the frequency distribution of H. pylori from human stool was 19.6%. Concerning animal breed, native breed of cattle and their milk showed higher occurrence (5.2% in cow's faeces, 11.9% in buffalo's faeces, 7% of cow's milk and 17.7% of buffalo's milk). Regarding animal age, the occurrence of H. pylori was increased with increasing age. On the other hand, the frequency distribution of H. pylori was more prevalent in the samples (faeces and milk) collected from Mansoura center. In relation to human samples, with respect to gender, males showed higher isolation rate (11.7%) than females (7.8%). Whereas, frequency of H. pylori in adults (4.9%) was higher than young (1.96%). On the other hand, H. pylori was more frequently isolated from patients (8.8%) with gastrointestinal disorders. Moreover, the occurrence of H. pylori was higher in human samples collected from persons of occupations related to animals such as veterinarians (6.8%), dairy workers, and farmers (3.92% each) than others. It could be concluded that H. pylori could be isolated from cattle, milk and humans with recognizable percentages, suggesting its zoonotic significance and role played by cattle especially buffaloes and its milk as potential reservoir and source of human infection. The zoonotic significance for H. pylori as well as the recommended preventive measures which should be taken to avoid the risk of contamination of milk and human infection were fully discussed.

Epidemiology of Helicobacter pylori infection in six Latin American countries (SWOG Trial S0701)

To investigate the potential determinants of Helicobacter pylori infection between adults 21-65 years old. Data are from the initial screening visit of a randomized clinical trial of three antibiotic regimens to eradicate H. pylori, conducted in seven sites (Santiago-Chile, Túquerres-Colombia, Guanacaste-Costa Rica, Copán-Honduras, Obregón and Tapachula-México, León-Nicaragua). Thousand eight hundred and fifty-nine adults from the general population were screened for H. pylori infection using an urea breath test (UBT) and were interviewed to assess socioeconomic-, demographic-, and symptom-related characteristics. Logistic regression was used to assess the relationship between these characteristics and H. pylori positivity at enrollment. Among the 1,852 eligible participants for whom a conclusive UBT result was obtained, H. pylori prevalence was 79.4 %, ranging from 70.1 to 84.7 % among the seven centers. Prevalence did not differ by sex (female: 78.4, male: 80.9; p = 0.20) or age (p = 0.08). H. pylori positivity increased with increasing number of siblings (p trend <0.0001). Participants with education beyond 12 years were less likely to be UBT-positive (OR 0.4: 0.3-0.6, compared to participants with 0-6 years of schooling) as were those employed outside the home (OR 0.7: 0.6-1.0). Odds of H. pylori infection increased with the presence of certain living conditions during childhood including having lived in a household with an earth floor (OR 1.8: 1.4-2.4), lack of indoor plumbing (OR 1.3: 1.0-1.8) and crowding (OR 1.4: 1.0-1.8, for having more than two persons per bedroom). Regarding current household conditions, living with more than 3 children in the household (OR 1.7: 1.2-2.5) and crowding (OR 1.8: 1.3-2.3) were associated with H. pylori infection. The prevalence of H. pylori in adults was high and differed significantly among the six Latin American countries studied (p < 0.001). Our findings confirm the strong link between poor socioeconomic conditions and H. pylori infection.

Ten-Day Sequential Therapy of Helicobacter pylori Infection in Thailand

Antimicrobial resistance has decreased eradication rates of Helicobacter pylori worldwide. The objective of this study was to determine whether a sequential therapy regimen is effective in eradicating H. pylori in adults with nonulcer dyspepsia or peptic ulcer disease in Thailand. A total of 115 patients with dyspepsia or peptic ulcer were enrolled in the study. (14)C-urea breath test, upper endoscopy, rapid urease test, bacterial culture, and antibiotic resistance assessment were conducted during the course of the treatment. In all, 115 patients underwent a 10-day sequential regimen, which consisted of lansoprazole (30 mg) plus amoxicillin (1 g) twice a day for 5 days, then lansoprazole (30 mg) with metronidazole (500 mg) twice a day, and clarithromycin (1,000 mg) once a day for another 5 consecutive days. Successful eradication was evaluated by negative urea breath test at least 4 weeks after stopping treatment. Successful eradication was achieved in 106 of 115 patients (95%). All patients completed the treatment, without any dropouts. Mild adverse effects included headache and palpitations. The prevalence rate of clarithromycin-resistant H. pylori was found to be 6.1%. The 10-day sequential treatment for H. pylori is well tolerated and provides a high eradication rate. This regimen can overcome the emergence of antibiotic resistance and may have a role as a first-line treatment for H. pylori infection in Thailand.

Meta‐analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first‐line therapies for Helicobacter pylori

Information regarding the effects of drug resistance on therapies for Helicobacter pylori is limited. To determine the effect of drug resistance on the efficacy of first-line treatment regimens for H. pylori and identify the most efficacious treatments in the presence of drug resistance. We searched for studies using the keywords: 'Helicobacter pylori','resistance' and 'treatment' or 'therapy'. Multilevel meta-regression models were used to determine the effect of drug resistance on treatment efficacy. We analysed data from 93 studies with 10,178 participants. For triple therapies, clarithromycin resistance had a greater effect on treatment efficacy than nitroimidazole resistance. Metronidazole resistance reduced efficacy by 26% in triple therapies containing a nitroimidazole, tetracycline and bismuth, while efficacy was reduced by only 14% when a gastric acid inhibitor was added to the regimen. Quadruple therapies containing both clarithromycin and metronidazole were the most efficacious; >80% of H. pylori infections were consistently eradicated with these regimens. Drug resistance was a strong predictor of efficacy across triple therapies for the eradication of H. pylori in adults. Resistance to either clarithromycin or metronidazole, but not both simultaneously, may be overcome by using quadruple therapies, especially those containing both clarithromycin and metronidazole.

Specific serum immunoglobulin G to H pylori and CagA in healthy children and adults (south-east of Iran)

To evaluate the serologic IgG response to H pylori and CagA across age groups and in healthy children and adults. Totally, 386 children aged 1-15 years and 200 adults aged 20-60 years, were enrolled to study. The serum samples of participant were tested for presence of anti-H pylori and anti-CagA IgG by using ELISA method. The seroprevalence of H pylori in adults was significantly higher than that observed in children (67.5% vs 46.6%; P < 0.000003). In children, the seropositivity rate in males (51.9%) was significantly (P < 0.05) higher than that observed in females (41.7%). The prevalence of serum anti-CagA antibody was 72.8% and 67.4% in infected children and adults, respectively. The mean titer of serum anti-CagA antibodies was significantly higher among children in comparison to adults (64.1 Uarb/mL vs 30.7; P < 0.03). In infected children and adults the prevalence of serum anti-CagA antibody was higher in males compared to females (78.4% vs 66.3%; P = 0.07 and 75.6% vs 54.71%; P < 0.04, respectively). The age-specific prevalence of anti-H pylori and anti-CagA antibody (in infected subjects) was 37.6% and 59.57% at age 1-5 years, 46.9% and 75% at age 6-10 years, 54.9% and 79.45% at age 11-15, 59.01% and 83.33% at age 20-30 years, 66.6% and 60.52% at age 31-40 years, 73.46% and 63.88% at age 41-50 years and 75.75% and 60% at age 51-60 years with mean titer of anti-CagA antibody of 75.94, 63.32, 57.11, 52.06, 23.62, 21.52 and 21.80 Uarb/mL, respectively. There was significant difference between mean serum anti-CagA antibody in age subgroups (P < 0.001). These results showed that anti-H pylori and anti-CagA antibodies were common in the children and adults. The H pylori-specific antibodies influenced by age and sex of subjects. Moreover, it seems that males are more susceptible to infection with CagA(+) strains compared to females. The seroprevalence of anti-CagA antibody was increased with age, up to 30 years and then decreased. It was also found that the magnitude of the IgG response to CagA decreased with advanced age.

Breath Test Using A Single 50‐mg Dose of 13C‐Urea to Detect Helicobacter pylori Infection in Children

ABSTRACTBackgroundThe 13C‐urea breath test is an accurate, noninvasive method for the diagnosis of Helicobacter pylori in adults. A dose of 75 to 100 mg of urea is generally used, especially in adults, but the optimal dose in children is still unknown. Our aim was to determine whether urea breath test performed with a single 50‐mg dose of 13C‐urea was sufficient and accurate for diagnosing H. pylori infection in children.MethodsConsecutive children 4 to 14 years of age undergoing upper intestinal endoscopy to evaluate symptoms of recurrent abdominal pain were prospectively included. Exclusion criteria included use of antibiotics or proton pump inhibitors during the last month, gastric surgery, and previous H. pylori eradication therapy. Reference criteria for diagnosis of infection were based on histology, culture, and serology. Urea breath test (TAU‐KIT; Isomed, S.L., Madrid, Spain) was performed as follows: citric acid (Citral pylori) dissolved in 100 mL of water was initially given. Ten minutes later, a baseline exhaled breath sample was collected, and thereafter 50 mg of 13C‐urea dissolved in 50 mL of water was given. A second breath sample was obtained 30 minutes later. Breath samples were analyzed by isotope ratio mass spectrometry. The endoscopist, the pathologist, the microbiologist, and the person responsible for reading the serology and the urea breath test were all unaware of H. pylori status by the other diagnostic methods.ResultsOne hundred children were included (40% males; mean age, 9.2 ± 2 years; mean weight, 33.9 ± 12 kg). Based on the reference criteria, 45% were infected, 37% were not infected, and 18% were indeterminate. Sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 91% (95% confidence interval [CI], 79%–96%), 97% (95% CI, 86%–99%), 98% (95% CI, 87%–91%), and 90% (95% CI, 76%–96%). Positive and negative likelihood ratios were of 33 and 0.09. Any cutoff point between 2 and 14 δ units had the same high diagnostic accuracy. The area under the receiver operating characteristic curve was 0.94. No adverse effects were reported.ConclusionUrea breath test using 50 mg of urea is sufficient and accurate for the diagnosis of H. pylori infection in children. Use of a small test dose significantly lowers the cost of the test.

Helicobacter pylori gastritis in children and adults: Comparative histopathologic study

The inflammatory response to Helicobacter pylori in adults has been well characterized. In children, studies of H. pylori gastritis have been based on small numbers of patients and have used loose definitions of the inflammatory components. Comparative study of the inflammatory response to H. pylori in children and adults can help our understanding of the natural history of this infection. Using the Updated Sydney Classification, we performed a retrospective, blinded pathology review of gastric biopsy specimens from 42 children and 40 adults with H. pylori infection, and we quantified each inflammatory cell separately (neutrophils, lymphocytes, plasma cells, and eosinophils). Differences in inflammatory cell components of children and adults were assessed by logistic regression analysis. More children had marked amounts of H. pylori (P = .05) and mild degree of neutrophils (P = .02), plasma cells (P = .005), and eosinophils (P = .0001) compared with adults. No differences existed when quantifying mononuclear cells or atrophy. Ulcers and intestinal metaplasia were present only in adults. We found that the numbers of inflammatory cells present in H. pylori-infected biopsy specimens is different in children and adults. We hypothesize that these differences demonstrate how H. pylori infection evolves from an acute childhood infection to an adult chronic disease.

Seroconversion for Helicobacter pylori in adults from Brazil

We studied, prospectively, seroconversion for Helicobacter pylori in adults from a developing country and investigated risk factors for the acquisition of the microorganism in this population. A group of 213 volunteers of low socioeconomic level from a district in the metropolitan area of Belo Horizonte, south-east Brazil was evaluated. Anti- H. pylori IgG antibodies were measured by ELISA using Cobas Core anti- H. pylori EIA (Roche) in serum samples collected in 1992 and in 1997. The subjects were interviewed and sociodemographic data were collected. A total of 174 (81·7%) subjects presented anti- H. pylori antibodies on the occasion of the first visit. During 56 months of follow-up, 2 of 39 seronegative adults converted to seropositive with an annual infection rate of 1·1%, and 2 of 174 seropositive subjects reverted to seronegative (0·2%/year). The prevalence of infection increased significantly with age and an inverse association was observed between prevalence of infection and educational level. In conclusion, the results of the present study demonstrate that in a developing country there is a low but continuous risk of H. pylori infection in adulthood.

Helicobacter pylori in childhood: new insights into the immunopathogenesis of gastric disease and implications for managing infection in children.

Helicobacter pylori in childhood: new insights into the immunopathogenesis of gastric disease and implications for managing infection in children.

Detection of Helicobacter pylori Infection in Children with a Standardized and Simplified 13C‐Urea Breath Test

ABSTRACTBackground:The 13C‐urea breath test, a reliable noninvasive method of detection of Helicobacter pylori in adults, needs validation in children.Methods:In order to evaluate the diagnostic accuracy of 13C‐urea breath test in children, the results of this test performed in 144 children were correlated with the histology and culture of contemporaneous gastric (antral and fundic) biopsy specimens. The test was performed with 2 mg/kg body weight13 C‐Urea (maximum, 100 mg) ingested after a fat‐rich test meal. Samples of expired breath taken at 0, 5, 10, 20, and 30 minutes were assayed with mass spectrometry. Results were considered positive when the curve of excretion of labeled carbon dioxide in the expired breath increased by 5‰ or more above the baseline.Results:Discrepancies in H. pylori status were observed in 14 children. To improve and simplify the test, the results were reanalyzed using different cutoff values for each sampling time. The best results, with sensitivity of 95.7% and specificity of 95.2%, were obtained with a cutoff of 3.5‰ at 20 minutes.Conclusions:The 13C‐urea breath test is a reliable method for the noninvasive detection of H. pylori infection in children. The test can be simplified and its accuracy improved using only the 0‐ and 20‐minute breath samples and a cutoff of 3.5‰ instead of the classical 5‰ used in adults. The need for modification of the cutoff value may reflect the higher production of endogenous CO2 in children.