A team from Germany investigated the diagnostic properties of the 13C-urea breath test (13C-UBT) prospectively in patients with partial gastric resection due to peptic ulcer disease.
The study recruited hospitalized patients, with previous gastric resection, and indications for upper gastrointestinal endoscopy.
68 patients were included in the investigation (47 male, 21 female; mean age 62 years).
Biopsy specimens were obtained from the fundus mucosa and the gastric remnant adjacent to the gastroenteric anastomosis. These were used for histological examination and rapid urease test (HUT test).
Breath-tests cannot be recommended for H. pylori diagnosis in patients who have had partial resection due to peptic ulcer disease.
Histological slides were evaluated after hematoxylin and eosin and Warthin-Starry dye staining.
The patients were given 200 ml of orange juice orally after two baseline breath samples had been taken. Thirty minutes after ingestion of 75 mg 13C urea, two more breath samples were obtained and analyzed by ratio mass spectrometry. The Warthin-Starry dye-stained sample was taken as reference.
The overall prevalence of histologically proven Helicobacter pylori infection was 36.7%.
The researchers found that the sensitivity of the 13C-UBT was 52%, and the specificity 93%. The positive predictive value was 81.25%, whilst the negative predictive value was 76.9%. The accuracy was found to be 77.9%.
The sensitivity of the HUT test reached 60%, and the specificity 97%.
The diagnostic accuracy of 13C-UBT, compared with the Warthin-Starry dye staining was low, commented the authors.
Researcher D. Schilling concluded on behalf of the group, "The breath-test, performed in the above-described manner, cannot be recommended as a noninvasive diagnostic tool for diagnosis of H. pylori infection in patients after partial gastrectomy as a result of peptic ulcer disease."