Breath Test Results Research Articles

Hydrogen–methane breath testing results influenced by oral hygiene

Rationale: Criteria for preparation of the oral cavity is not a standard inclusion in current guidelines for hydrogen-methane breath testing. The aim of this study was to determine how a pre-test mouthwash may impact breath test Results upon which diagnosis and treatment recommendations are based.

Роль кишкової мікробіоти в розвитку порушень ліпідного та вуглеводного обміну при стеатозі печінки у дітей

У 34 дітей із різним ступенем стеатозу печінки був досліджений за допомогою водневого дихального тесту стан мікробіоти тонкого кишечника. Виявлений у третини дітей із стеатозом печінки (переважно третього ступеня) синдром надмірного бактеріального росту сприяв розвитку інсулінорезистентності, дисліпідемії, зокрема, ІІа типу (у 34,0 % дітей), ІІb типу (34,0 %), IV типу (17,0 %) та ізольованого зниження рівня холестерину ліпопротеїнів високої щільності (17,0 %).

Hydrogen and Methane Breath Test in the Diagnosis of Lactose Intolerance

The hydrogen (H2) breath test is a non-invasive investigation used to diagnose lactose intolerance (LI). Patients with LI may also expire increased amounts of methane (CH4) during a lactose test. The aim of this study is to evaluate the contribution of CH4 measurements. We tested 209 children (1–17 years old) with symptoms suggesting LI with lactose H2 and CH4 breath tests. The result was positive when the H2 excretion exceeded 20 parts per million (ppm) and the CH4 was 10 ppm above the baseline. A clinician, blinded for the results of the breath test, registered the symptoms. Of the patient population, 101/209 (48%) were negative for both H2 and CH4; 96/209 (46%) had a positive H2 breath test result; 31/96 (32%) were also positive for CH4; 12/209 (6%) patients were only positive for CH4. The majority of hydrogen producers showed symptoms, whereas this was only the case in half of the H2-negative CH4 producers. Almost all patients treated with a lactose-poor diet reported significant symptom improvement. These results indicate that CH4 measurements may possibly be of additional value for the diagnosis of LI, since 5.7% of patients were negative for H2 and positive for CH4, and half of them experienced symptoms during the test.

The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth.

BackgroundSmall intestinal bacterial overgrowth treatment is usually based on antibiotics with no guidelines available.ObjectiveThis study aimed to investigate the efficacy of different antibiotics to treat small intestinal bacterial overgrowth.MethodsConsecutive patients referred to our tertiary center and diagnosed with intestinal bacterial overgrowth were retrospectively included. Patients were diagnosed using a 75 g glucose breath test. Patients were treated either with a single antibiotic (quinolone or azole) or rotating antibiotics (quinolone and azole, one after the other) for 10 consecutive days per month for 3 months. A negative glucose breath test after antibiotic treatment was considered as remission. Quality of life (GIQLI) and gastrointestinal severity (IBS‐SSS) were assessed before and after antibiotic treatment. Symptomatic evaluation was realized in simple blind of glucose breath test result: patients were unaware of their results.ResultsBetween August 2005 and February 2020, 223 patients were included in the analysis (female 79.8%, mean age 50.2 ± 15.7 years). Remission was observed in 119 patients (53.4%) after one course of antibiotics and was more frequent in patients receiving rotating antibiotics than in patients receiving a single antibiotic (70.0% vs. 50.8%, p = 0.050). Remission was associated with a significant improvement in quality of life (p = 0.035) and in bloating (p = 0.004).ConclusionIn this study, the treatment of small intestinal bacterial overgrowth using rotating antibiotics was more effective than treatment using a single course of antibiotic. Remission was associated with improvement in both quality of life and bloating.

Characteristics of oxygen concentration and the role of correction factor in real-time GI breath test

ObjectiveA high quality end-expiratory breath sample is required for a reliable gastrointestinal breath test result. Oxygen (O2) concentration in the breath sample can be used as a quality marker. This...

Hydrogen\u2013methane breath testing results influenced by oral hygiene

The measurement of hydrogen–methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Laboratories offering breath testing provide variable guidance regarding oral hygiene practices prior to testing. Given that oral dysbiosis has the potential to cause changes in breath gases, it raises concerns that oral hygiene is not a standard inclusion in current breath testing guidelines. The aim of this study was to determine how a pre-test mouthwash may impact hydrogen–methane breath test results. Participants presenting for breath testing who had elevated baseline gases were given a chlorhexidine mouthwash. If a substantial reduction in expired hydrogen or methane occurred after the mouthwash, breath samples were collected before and after a mouthwash at all breath sample collection points for the duration of testing. Data were evaluated to determine how the mouthwash might influence test results and diagnostic status. In 388 consecutive hydrogen–methane breath tests, modifiable elevations occurred in 24.7%. Administration of a chlorhexidine mouthwash resulted in significantly (p ≤ 0.05) reduced breath hydrogen in 67% and/or methane gas in 93% of those consenting to inclusion. In some cases, this modified the diagnosis. Mean total gas concentrations pre- and post-mouthwash were 221.0 ppm and 152.1 ppm (p < 0.0001) for hydrogen, and 368.9 ppm and 249.8 ppm (p < 0.0001) for methane. Data suggest that a single mouthwash at baseline has a high probability of returning a false positive diagnosis. Variations in gas production due to oral hygiene practices has significant impacts on test interpretation and the subsequent diagnosis. The role of oral dysbiosis in causing gastrointestinal symptoms also demands exploration as it may be an underlying factor in the presenting condition that was the basis for the referral.

Analysis of the prevalence of Helicobacter pylori infection and the effectiveness of eradication schemes in patients with the upper gastrointestinal tract disorders (according to the results of 13C-urea breath tests for 2006–2019)

IntroductionThe problem of Helicobacter pylori is relevant due to the high frequency of stomach and duodenum erosions and ulcers, as well as the possible development of metaplasia and gastric cancer. Therefore, it is especially important to study the dynamics of H. pylori infection and monitor the effectiveness of eradication schemes in different regions of Ukraine.AimTo study the dynamics of H. pylori infection and to evaluate the effectiveness of H. pylori eradication schemes in patients with upper gastrointestinal tract disorders – residents of the Vinnytsia region.Material and methodsWe retrospectively analysed 2205 results of 13C-urea breath tests, performed during 2006–2019 in the National Pirogov Memorial Medical University, Vinnytsya on an infrared analyser.ResultsIt was found that patients with upper gastrointestinal tract disorders since 2009 had significantly reduced primary H. pylori infection. Among the schemes designed according to the Maastricht recommendations, the most effective were as follows: proton pump inhibitor (PPI) + clarithromycin (Clar) + amoxicillin (Amox) – 81.6%, PPI + Clar + Amox + bismuth subcitrate (Bi) – 87%, and PPI + tetracycline (TC) + metronidazole derivatives (MNZ) + Bi – 83.9%. The lowest efficiency was recorded for the scheme PPI + Clar + MNZ, at 68.1%.ConclusionsDespite the gradual decrease in H. pylori infection in the general population, its prevalence remains quite high among the elderly. This dictates that a thorough examination be carried out for patients with disorders of the upper G.I. tract to detect the presence of H. pylori infection, and if infection is detected, the correct selection of eradication therapy.

Оцінка ефективності замісної ферментної терапії зовнішньосекреторної недостатності підшлункової залози у хворих на цукровий діабет та хронічний панкреатит

The study of the combined course of chronic pancreatitis and diabetes mellitus present a particular interest. The purpose of the study was to determine the effectiveness of correction of exocrine pancreatic insufficiency of the pancreas in patients with chronic pancreatitis and diabetes mellitus types 1 and 2 with using of different forms and doses of polyenzyme drugs. Material and methods. 126 patients with diabetes mellitus and chronic pancreatitis were examined. The patients were divided into 2 groups: 1 group included 62 patients with type 1 diabetes mellitus, and 2 group comprised 64 patients with type 2 diabetes. All surveyed patients underwent general clinical, anthropometric, instrumental and laboratory methods of investigation. Patients of both groups were divided into subgroups depending on the method of correction of exocrine pancreatic insufficiency, namely 1.1 and 2.1 subgroups received tableted polyenzyme preparation with minimal lipase activity of 10000 IU as enzyme therapy, and 1.2 and 2.2 subgroups received mini-tableted polyenzyme preparation with minimal lipase activity of 25000 IU. Results and discussion. The use of mini-tableted polyenzyme preparation with minimal lipase activity of 25000 IU according to the results of C13-mixed triglyceride and C13-amylase breath tests was an effective method for the correction of exocrine insufficiency of the pancreas in patients with chronic pancreatitis and diabetes mellitus types 1 and 2. We detected a statistically significant increase of the maximally concentration of 13CO2 between 150 and 210 minutes of the study (up to 9.2±0.4% 1.2 subgroup and up to 9.7±0.5% in patients 2.2 subgroup), as well as the total concentration of 13CO2 in at the end of 360 minutes of the study (up to 19.7±0.6% and up to 27.3±1.1%) according to the results of C13-mixed triglyceride breath tests, p&lt;0,05. Conclusion. The use of a mini-tableted polyenzyme preparation with a minimum lipase activity of 25000 IU was a more effective method for correction of exocrine pancreatic insufficiency in patients with chronic pancreatitis and type 1 and 2 diabetes mellitus, than using a tableted polyenzyme preparation in a dose of 20000 IU per main meal. The study results showed that using C13-mixed triglyceride and C13-amylase breath test were highly informative methods for evaluating the effectiveness of enzyme replacement therapy in exocrine pancreatic insufficiency in patients with chronic pancreatitis and type 1 and 2 diabetes. The use of a mini-tablet polyenzyme drug in patients with chronic pancreatitis and type 1 and 2 diabetes mellitus is an effective means to normalize the manifestations of malabsorption in terms of α1-antitrypsin clearance

Prevalence of Helicobacter pylori in Vinnytsia region and the effectiveness of the eradication schemes according to 13C-urease breath tests (2006 — 2019)

Objective — On the basis of analysis of the results of breath tests with 13C‑labeled urea, to study the dynamics of the level of H. pylori infection and to assess the effectiveness of H. pylori eradication schemes in patients with disorders of the upper gastrointestinal tract (GIT) — residents of the Vinnytsia region.Materials and methods. The analysis has been carried out with 2095 results of breath tests with 13C‑labeled urea, performed on infrared analyzer (IRIS, Wagner, Germany) during the years 2006 — 2019 in the clinical diagnostic gastroenterological laboratory of the Vinnytsia National Pirogov memorial Medical University. The results of breath tests with 13C‑labelled urea were divided into two data arrays. The first data array included results of 1189 breath tests (644 women and 545 men), performed in patients with upper gastrointestinal tract disorders for the primary H. pylori infection diagnosis, the second consisted of 906 breath tests results (476 women and 430 men), performed in patients with upper gastrointestinal tract disorders in order to monitor the effectiveness of H. pylori eradication.Results. Based on the results of the analysis of breath tests, performed for the primary diagnosis of H. pylori infection in patients of upper gastrointestinal tract disorders, it has been established that in the years 2006, 2007 and 2008 the H. pylori infection level did not differ from each other (p &gt; 0.05) and amounted to 68.1 %, 63.3 %, 64.8 %, respectively. Starting from year 2009, in patients who did not receive previous anti‑helicobacter pharmacotherapy, the H. pylori infection level has significantly decreased (p &lt; 0.05 and &lt; 0.01). The mean rate of the effective H. pylori eradication for the whole observation period was 76.4 % regardless of the treatment regimen. The comparison of the efficacy of eradication pharmacotherapy depending on gender showed that in the years 2006 and 2007 the rate of successful eradication pharmacotherapy in women was significantly (р &lt; 0.01) lower vs men and was 53.5 % and 60.0 % vs 77.9 % vs 91.3 % respectively. The number of successful H. pylori eradications was significantly higher (p &lt; 0.01) in the group of patients who were administered anti‑helicobacter pharmacotherapy schemes in accordance with the Maastricht recommendations (81.3 % versus 65.6 %).Conclusions. According to the results of the analysis of breath tests with 13C‑labeled urea, performed for the primary diagnosis of H. pylori, it has been established, that in patients with disorders of the upper gastrointestinal tract since 2009, the primary infection with H. pylori significantly decreased. There were significant differences regarding primary infection with H. pylori between men and women with upper gastrointestinal tract disorders. The lowest level of H. pylori infection among patients with upper gastrointestinal tract disorders was observed in the age group under 20 years old (39.6 %), and the maximal H. pylori infection was diagnosed in the age group over 70 years old (66.7 %). The scheme proton pump inhibitor + clarithromycin + amoxicillin + bismuth subcitrate in standard doses demonstrated the highest efficacy of 87.0 % among the schemes, administered in accordance with с Maastricht recommendations. The scheme proton pump inhibitor + clarithromycin + derivatives of metronidazole in standard doses had the lowest efficacy (68.1 %).

Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients.

Contention surrounds hydrogen and methane breath tests as putative measures of small intestinal bacterial overgrowth. We aimed to explore the clinical characteristics associated with positive and negative results to help clarify their role. 525 glucose hydrogen/methane breath tests completed over 3years were analyzed to look for positively and negatively associated predictive factors. Characteristics such as height and weight and underlying medical conditions, medications, and surgical history were collated. There were 85 and 42 positive hydrogen and methane tests, respectively. Patients with irritable bowel syndrome (IBS) (HR = 0.17, p=0.004) and those with a higher body mass index (HR = 0.93, p=0.004) were significantly less likely to have a positive test. Patients who underwent the test post-surgically were significantly more likely to have a positive test (HR = 2.76, p=0.001). A sub-analysis of post-surgical patients by type and region of surgical resection demonstrated that none were statistically more likely than the next to have a positive test. However, for the surgical group as a whole the number of motility-depressing drugs taken (such as opioids) was associated with a significantly decreased likelihood of a positive test (HR = 0.752, p=0.045). Our data suggest that patients with a diagnosis of IBS are statistically less likely to have a positive test and it is of limited utility in this group. Post-surgical patients are more likely to have a positive test, possibly secondary to fast transit rather than bacterial overgrowth, as suggested by a significantly negative association with motility-suppressing drugs in this sub-group.

S1300 The Relationship Between Serum IgA Level, Small Intestinal Bacterial Overgrowth (SIBO), and Ethnicity

INTRODUCTION: Secretory immunoglobulin A (IgA) is critical in preventing pathogen overgrowth in the gastrointestinal tract. IgA production is stimulated by the colonization of bacteria. The relationship between serum IgA level & incidence of small intestinal bacterial overgrowth (SIBO) in symptomatic patients has not been studied. Patients with selective IgA deficiency with a critically low serum IgA level (< 7 mg/dL) & normal IgM & IgG levels have a 10- to 20-fold increased risk for celiac disease, however an increased risk for SIBO has not been documented. The aim of this retrospective observational study was to determine the relationship of abnormal serum IgA level as a possible risk factor for SIBO with stratification based on ethnicity. METHODS: A retrospective electronic chart review was performed of all patients seen in the gastroenterology clinic who underwent breath hydrogen testing for SIBO & had serum IgA level measurement from 12/1/2010 to 1/1/2020 via clinical data query. The relationship between serum IgA level, SIBO percentage in symptomatic patients via breath test results & patient demographics was studied. Continuous variables are presented by median & IQR. Categorical variables are presented by counts & percent. X2 test was used to test association between breath test results (abnormal/negative) & IgA levels (3 levels- reduced, normal & elevated). All statistical tests were performed at an α = 0.05 level of significance, using two-sided tests. RESULTS: 561 patients underwent breath hydrogen testing from 12/1/2010 to 1/1/2020 with documented serum IgA level, of which 73% were female, 53.7% Hispanic. 39.4% of breath tests were positive for SIBO; 3.7% were nondiagnostic. SIBO percentage was highest in patients with reduced IgA level (14/29, 48.3%) compared to normal (40.5%) or elevated IgA level (41.4%) (P = 0.7067). Reduced IgA level was more common in non-Hispanics than Hispanics (7.66 vs. 3.44%) whereas elevated IgA level was more common in Hispanics (7.22 vs. 3.40%). SIBO was more common in non-Hispanics with reduced IgA level than Hispanics (11/19, 57.9% vs. 3/12, 25%). CONCLUSION: The overall rate of SIBO is higher though not statistically significant in patients with reduced IgA. This may be due to an overall paucity of patients with abnormal IgA level in our population. Further, differences in ethnicity may impact IgA level & potential for SIBO. Future larger studies should explore the relationship of abnormal IgA level, SIBO & ethnicity.

Efficacy of Helicobacter pylori eradication on recovery of chronic urticaria

Introduction: The studies have been equivocal about the association of Helicobacter pylori infection with chronic urticaria (CU) given some controversial evidence in recovery of urticaria following H. pylori eradication. Methods: In this clinical trial, 120 patients between the ages of 4 and 20 with intractable CU were recruited. They were grouped into two categories based on urea breath test (UBT) result. UBT positive group received treatment and UBT was repeated after two months while being evaluated for clinical course over a six-month period. On the other hand, UBT negative group received standard treatment for urticaria. Results: All participants with CU have been studied as 40 cases of UBT positive and 80 cases of control group with negative UBT, consisted of 42 (35%) male and 78 (65%) female. Patients had suffered from urticaria on average 29.9 (±26.6) months prior to diagnosis. Statistically significant difference was noted between two groups, in terms of severity of urticaria, frequency of episodes, abdominal pain and duration of being symptomatic prior to diagnosis. After receiving treatment for H. pylori infection, among case group, 27(67.5%) of individuals achieved complete recovery of urticaria and 13 (32.5%) cases demonstrated partial resolution of urticaria, meanwhile 59 cases (73.8%) of control group became completely symptom-free, while 21 (26.3%) of the remaining individuals were in incomplete recovery. In comparison of response to treatment between the above-mentioned groups, there was not any statistically significant difference (P=0.47) Conclusion: Our findings reveal that H. pylori infection might contribute to developing CU which highlights the significance of H. pylori eradication as an approach for CU.

Testing Antemortem Blood for Ethanol Concentration from a Blood Kit in a Refrigerator Fire

The stability of ethanol in antemortem blood stored under various conditions has been widely studied. Antemortem blood samples stored at refrigerated temperature, at room temperature, and at elevated temperatures tend to decrease in ethanol concentration with storage. It appears that the stability of ethanol in blood exposed to temperatures greater than 38°C has not been evaluated. The case presented here involves comparison of breath test results with subsequent analysis of blood drawn at the time of breath testing. However, the blood tubes were in a refrigerator fire followed by refrigerated storage for 5months prior to analysis by headspace gas chromatography. The subject's breath was tested twice using an Intoxilyzer 8000. The subject's blood was tested in duplicate using an Agilent headspace gas chromatograph. The measured breath ethanol concentration was 0.103g/210L and 0.092g/210L. The measured blood ethanol concentration was 0.0932g/dL for both samples analyzed. Although the mean blood test result was slightly lower than the mean breath test result, the mean breath test result was within the estimated uncertainty of the mean blood test result. Even under the extreme conditions of the blood kit being in a refrigerator fire, the measured blood ethanol content agreed well with the paired breath ethanol test.

Association between Severity of Dyspepsia and Urea Breath Test Results in Patients with Positive Helicobacter pylori Serology

Background: Active Helicobacter pylori infection is considered to cause more severe dyspepsia symptoms compared to inactive infection. This study was aimed to determine the association between severity of dyspepsia and urea breath test (UBT) results in subjects with positive H. pylori serology.Method: This study was a cross-sectional study in 60 subjects with positive H. pylori serology in Provincial General Hospital of West Nusa Tenggara. Severity of dyspepsia was measured using modified Glasgow Dyspepsia Severity Score (GDSS) questionnaire. Diagnosis of active H. pylori infection was made using 14C UBT examination.Results: Proportion of active H. pylori infection in subjects with positive serology was 20%. The average of modified GDSS score in all patients was 1.95 (SD + 1.78), with minimal score of 0 and maximal score of 7. There was a statistically significant difference between average of modified GDSS score and positive and negative UBT results, (p = 0.027). The cut-off point value of modified GDSS to diagnose positive UBT was 3.8. Results of diagnostic test with modified GDSS as a test and UBT results as the gold standard indicated sensitivity of 41.6% and specificity of 85.4%. Conclusion: There was a significant difference between modified GDSS score in patients and positive and negative H. pylori infection. In areas which did not have UBT examination, eradication in patients with positive serology and GDSS score of more than or equal to 4 could be considered.

Synthesis of Interleukin-10 in Patients with Ulcerative Colitis and Helicobacter pylori Infection.

Methods Detection of H. pylori infection was performed by a 13C-urea breath test in 31 patients with UC. In each patient, a serum sample was drawn to measure IL-10 by the ELISA technique. Based on the primary breath test result, two groups were formed and serum IL-10 was measured. Results Serological IL-10 levels in patients with UC and negative 13C-urea breath test was 10.28 pg/ml whereas in patients with UC and positive 13C-urea breath test was 5.5 pg/ml (P = 0.035). IL-10 levels were higher in the inflammatory endoscopic and histological active groups which tested positive in the 13C-urea breath tests for H. pylori (P < 0.05).Conclusions The role of IL-10 secretion in patients with UC in determining the clinicopathological outcome of infection merits further study. This study suggests an association between serum IL-10 and disease severity in patients with UC and HP infection.

Short-course Rifaximin therapy efficacy and lactulose hydrogen breath test in Chinese patients with diarrhea-predominant irritable bowel syndrome

BackgroundGut microbiota alterations including small intestinal bacterial overgrowth (SIBO) might play a role in pathogenesis of irritable bowel syndrome (IBS). Rifaximin could effectively and safely improve IBS symptoms. The aim of this study was to investigate the effect of rifaximin on Gastrointestinal (GI) symptoms, quality of life (QOL) and SIBO eradication in Chinese IBS-D patients.MethodsThis study included 78 IBS-D patients defined by the Rome IV criteria. Patients received 400 mg rifaximin twice daily for 2 weeks and 10-week follow-up. GI symptoms were assessed at week 0, 2, 4, 8 and 12. QOL and lactulose hydrogen breath test (LHBT) results were estimated at week 0 and 4.ResultsAll participants showed significant improvements in GI symptom subdomains after rifaximin treatment (all P < 0.05), which could maintain at least 10 weeks of follow-up. Additionally, QOL scores were increased with concomitant improvement of clinical symptoms (all P < 0.05). The 45 rifaximin-responsive patients (57.7%) achieved significantly greater GI-symptom improvement than non-responders (all P < 0.05). No GI symptoms were associated with SIBO (all P > 0.05). SIBO normalization after rifaximin treatment measured by LHBT was found in 44.4% (20/45) of patients with SIBO before treatment.ConclusionA short course (2 weeks) of rifaximin improved GI symptoms and QOL in Chinese IBS-D patients whether they had SIBO or not. However, the efficacy of rifaximin could not be explained by the successful eradication of SIBO. Further studies on the therapeutic mechanisms of rifaximin in IBS are urgently needed.

Influencing Factors on Lactulose Breath Test Results

This study aimed to identify the demographic and clinical factors associated with positive breath-test results and to assess the relationship between hydrogen and methane production in patients with suspected irritable bowel syndrome (IBS). The demographic and clinical factors of 268 patients with suspected IBS, who had undergone a lactulose breath test, were analyzed. Of 268 patients included in this study, 143 (53.4%) were females. The median age and BMI of the patients was 58.0 years (range, 18.0-80.0 years) and 22.5 kg/m2 (range, 14.4-34.3 kg/m2), respectively. A weak positive correlation was observed between the BMI and baseline hydrogen level (rho=0.134, p=0.031). Women were significantly more likely to show a ≥20 ppm increase in hydrogen within 90 min (early hydrogen increase, p=0.049), a ≥10 ppm increase in methane within 90 min (early methane increase, p=0.001), and a ≥10 ppm increase in methane between 90 min and 180 min (late methane increase, p=0.002) compared to men. The baseline hydrogen level was related to the baseline methane level (rho=0.592, p<0.001) and the maximal hydrogen level within 90 min was related to maximal methane level within 90 min (rho=0.721, p<0.001). Patients with an early hydrogen increase (43.8%) were more likely to show a positive result for an early methane increase compared to patients without an early increase in hydrogen (0%, p<0.001). Women were associated with high rates of positive lactulose breath-test results. In addition, methane production was correlated with hydrogen production.

Randomized controlled study on the effects of triple therapy including vonoprazan or rabeprazole for the second-line treatment of Helicobacter pylori infection.

Background and Aim:Inhibition of gastric acid secretion is important for eradicating Helicobacter pylori. Vonoprazan (VPZ) is a strong, long-lasting inhibitor of gastric acid secretion. Studies that examined the effectiveness of VPZ-based triple therapy in second-line treatment have been performed. However, there have been no randomized controlled studies to compare the effect between VPZ-based triple therapy and proton pump inhibitor (PPI)-based triple therapy in second-line treatment, and it is not known which is more effective between VPZ-based and PPI-based therapies. This study aimed to compare the effectiveness of second-line triple therapies including VPZ or rabeprazole (RPZ) as the PPI.Methods:Eligible patients with H. pylori infection who failed first-line triple therapy were assigned randomly to the VPZ [VPZ40 mg/day, amoxicillin (AMPC) 1500 mg/day, metronidazole (MNZ) 500 mg/day] or RPZ (RPZ20 mg/day, AMPC1500 mg/day, MNZ500 mg/day) group. A 13C-urea breath test result of less than 2.5% was considered as successful eradication.Results:In total, 46 and 41 patients were analyzed as intention to treat (ITT) and per protocol (PP), respectively. Eradication rates in the VPZ and RPZ groups were 73.9% [95% confidence interval (CI) 51.6–89.8%] and 82.6% (95% CI 61.2–95.0%) based on ITT analysis, respectively (p = 0.72). Based on PP analysis, the eradication rates in the VPZ and RPZ groups were 89.5% (95% CI 66.9–98.7%) and 86.4% (95% CI 65.1–97.1%), respectively (p = 1.00). Two patients in the VPZ group and one in the RPZ group discontinued treatment due to side effects (p = 1.00).Conclusion:There were no significant differences in efficacy and safety between second-line therapies including VPZ or RPZ.

483 Phenotype and Antibiotic Response in Patients With Elevated Baseline Hydrogen Breath Test Results: A Large Scale Database Analysis

INTRODUCTION: Breath testing (BT) is a non-invasive method used for diagnosis of small intestinal bacterial overgrowth (SIBO). Elevated baseline hydrogen breath test results, defined as no excessive methane and elevated hydrogen production &gt;20 part per million (ppm), is an uncommon but important pattern in breath testing. This result has been difficult to understand in clinical settings. Multiple interpretations are used including an abnormal result suggesting SIBO or attributing to poor compliance with the diet for the test. Large-scale studies are lacking to explore the clinical characteristics of these patients and potential response to treatment regimens. METHODS: We reviewed a database of 14,847 consecutive lactulose breath tests performed between November 2005 and October 2013 at a single institution. All subjects underwent a low fermentation diet on the day prior to the test and fasted for at least 8 hours overnight. Compliance to diet and fasting was confirmed prior to testing. Breath tests with an elevated baseline hydrogen result (&gt;20 ppm) were identified. A retrospective chart review was performed to retrieve patient characteristics including age, gender, BMI, symptoms, and medications. Furthermore, the response to and type of antibiotic treatment was assessed. RESULTS: A cohort of 107 patients with elevated baseline hydrogen BT was identified. Basic demographics showed females comprising 72%, mean age 40.3 (std dev 19.3) and mean BMI = 24.2 kg/m2 (std dev 5.7). The most common symptoms experienced included abdominal pain (84%), bloating/distention (87%), fecal urgency (82%) and flatulence (80%) (Table 1). Regarding medications relevant to SIBO, patients used PPI (31%), chronic narcotics (21%), probiotics (5%) and antidiarrheals (10%). In patients who were treated with antibiotics after an elevated baseline hydrogen result (n = 22), 55% responded to antibiotics. Response rates in the rifaximin alone group (n = 11) and rifaximin plus neomycin group (n = 4) were 73% and 25% respectively (P &lt; 0.01) CONCLUSION: In the largest cohort of patients with elevated baseline hydrogen breath tests analyzed to date, the most common gastrointestinal symptoms were abdominal bloating, pain, and urgency. Response to rifaximin alone appeared better than rifaximin/neomycin however small sample sizes were analyzed. An elevated baseline hydrogen breath test can occur despite full compliance with diet and fasting prior to the test. Further prospective controlled studies are needed to validate these findings

ATG16L1 Single Nucleotide Polymorphism Confers High Cardiac Artery Disease Risk in H. Pylori Chronic Gastritis Patients

AbstractBackground: Chronic Helicobacter pylori (HP) gastritis affects two-thirds of the world's population and is one of the most common chronic inflammatory disorders of humans, the infection clearly results in chronic mucosal inflammation in the stomach and duodenum which in turn might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. The increased inflammatory response related to HP gastroin-testinal disease may also lead to damage in non-gastrointestinal tissues. The damage caused by HP is believed to be associated with increased inflammatory markers resulting from immune response and blood cells activation. Autophagy related gene 16 like 1 single nucleotide polymorphism (ATG16L1 SNP) may be associated with impaired autophagy which predisposes to HP persistence and chronicity. Chronic infection is a suspected risk factor for cardiac artery disease.Aim of Study: The aim of this study is to assess the association between (ATG16L1) SNP and coronary artery disease, pro-inflammatory and atherogenic risk factors in HP patients.Patients and Methods: This study was carried out on 80 patients suffering from dyspepsia and reflux symptoms. According to the urea breath test results, patients were divided into two groups: group I (45 positive H. pylori) patients and group II (35 negative H. pylori) patients as control group. All patients were subjected to full medical history taking, clinical examination and laboratory investigations included urea breath testing for H. pylori infection, complete blood count (CBC), (ATG16L1) SNP, pro-inflammatory HDL assay and high sensitivity CRP (hs-CRP) assay.Results: H. pylori gastritis patients with AG+GG genotypes had statistically higher levels of hs-CRP, N/L, P/L, pro-oxidant HDL-c index when compared to H. pylori gastritis patients with AA genotype and both patient groups had higher levels of these parameters when compared to healthy control subjectsConclusion: The ATG16L1 SNP impairs autophagy and has a role in persistence of H. pylori intracellular infection leading to chronic gastritis and increases the CAD pro-inflammatory pro-atherogenic risk factors; the mutant G allele is accused allele.