13C-urea breath test for diagnosis of Helicobacter pylori infection in the elderly

Dyspepsia Challenge in Primary Care Gastroenterology

BACKGROUND

The purpose of this review is to take a deep dive into general problems and challenges of diagnosis and treatment of patients with symptoms of dyspepsia in primary care practice.

SUMMARY

Primary care physicians become acquainted with a broad range of clinical problems and therefore require a wide span of knowledge in taking care of patients from their first medical examination within the health care system. Dyspepsia and Helicobacter pylori infection are two of the most frequent reasons of digestive-related health care issues, despite that in primary care practice, current recommendations for diagnosis and differential therapy are often not implemented. The "test-and-treat" strategy is the initial management of the condition, reserving gastroscopy for patients refractory to symptomatic treatment and for patients presenting with any of the following alarm signs: age of above 55, dysphagia, anemia, weight loss, frequent vomiting, family history of GI malignancy, or a physical examination with key pathological findings.

KEY MESSAGES

Examination and treatment of dyspepsia symptoms is the diagnostic and therapeutic challenge dictated by organizational and economic potentials of the health system, professional resources, and primary health care capabilities to accept and treat patients with dyspepsia and to properly refer those with alarm symptoms and findings indicative of organic disease to a gastroenterologist.

Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report

Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. pylori were re-evaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in the various clinical scenarios.

Helicobacter pylori infection in older people

Since the discovery of Helicobacter pylori (H. pylori) infection as the major cause of gastroduodenal disorders three decades ago, H. pylori has been the focus of active research and debate in the scientific community. Its linkage to several diseases, such as peptic ulcer disease, gastritis and gastric malignancy is incontestable. In particular, it has been noticed that, as the aged population is increasing worldwide, older people are at increased risk of developing several gastroduodenal diseases and related complications. At the same time, gastric cancer is definitely more frequent in elderly than in adult and young people. In addition, it has been showed that peptic ulcer and related complications occur much more commonly in aged individuals than in young people, resulting in a significantly higher mortality. Although this infection plays a crucial role in gastrointestinal disorders affecting all age groups and in particular older people, only a few studies have been published regarding the latter. This article presents an overview of the epidemiology, diagnosis, clinical manifestations and therapy of H. pylori infection in elderly people.

Helicobacter pylori recurrence and infection rate in Israeli adults

INTRODUCTION

In developing countries the recurrence rate of Helicobacter pylori after successful eradication therapy is as high as 42%, while in developed countries it is estimated to be less than 3%. Such figures are very important in terms of determining clinical strategy and outcome.

AIM

To estimate the recurrence rate of H. pylori in Israel using the database of the "Central H. Pylori Laboratory of Clalit Health Services".

METHODS

The database was searched for patients who had undergone the [(13)C]-urea breath test ([(13)C]-UBT) for validation of the successful eradication of H. pylori or for evaluation of dyspepsia 7 years previously and for whom the result had been negative. These patients were invited to participate in the trial, fill a symptom questionnaire and undergo another [(13)C]-UBT.

RESULTS

A In total, 65 patients participated; of these, 26 patients had tested negative in the first( 13)CUBT, indicating the successful eradication of H. pylori (Group A), and 39 had been tested for dyspepsia (Group B). One patient in each group had a positive [(13)C]-UBT - 3.84% in Group A and 2.56% in Group B (non-significant difference, NS). The mean annual H. pylori recurrence rate was calculated to be 0.55% and 0.37% in Group A and Group B patients, respectively (NS).

CONCLUSION

Our results shown a very low re-infection or new infection rates in Israeli adults and are in line with other trials in developed countries; they do not support the a retesting program for patients after a successful eradication therapy.

An optimized 13C-urea breath test for the diagnosis of H pylori infection

AIM: To validate an optimized 13C-urea breath test (¹³C-UBT) protocol for the diagnosis of H pylori infection that is cost-efficient and maintains excellent diagnostic accuracy.

METHODS: 70 healthy volunteers were tested with two simplified ¹³C-UBT protocols, with test meal (Protocol 2) and without test meal (Protocol 1). Breath samples were collected at 10, 20 and 30 min after ingestion of 50 mg ¹³C-urea dissolved in 10 mL of water, taken as a single swallow, followed by 200 mL of water (pH 6.0) and a circular motion around the waistline to homogenize the urea solution. Performance of both protocols was analyzed at various cut-off values. Results were validated against the European protocol.

RESULTS: According to the reference protocol, 65.7% individuals were positive for H pylori infection and 34.3% were negative. There were no significant differences in the ability of both protocols to correctly identify positive and negative H pylori individuals. However, only Protocol 1 with no test meal achieved accuracy, sensitivity, specificity, positive and negative predictive values of 100%. The highest values achieved by Protocol 2 were 98.57%, 97.83%, 100%, 100% and 100%, respectively.

CONCLUSION: A 10 min, 50 mg ¹³C-UBT with no test meal using a cut-off value of 2-2.5 is a highly accurate test for the diagnosis of H pylori infection at a reduced cost.