Is the Remarkable Contradiction between Histology and 14C Urea Breath Test in the Detection of Helicobacter pylori due to False-negative Histology or False-positive 14C Urea Breath Test?

We assessed the diagnostic value of the 14C urea breath test (UBT) in the detection of Helicobacter pylori compared with histology and the rapid urease test (RUT). The study included 68 patients (22 men and 46 women) with dyspeptic symptoms. H. pylori status was evaluated by 14C UBT, RUT and histology. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were determined for 14C UBT and for RUT. Histology revealed dense yeast-like micro-organisms in the biopsy specimens in all patients with false-positive results by 14C UBT (n = 8), a significantly higher proportion than in patients with negative 14C UBT (five of 31). The low specificity of the H. pylori 14C UBT should not be neglected by accepting histology results as false-negative. Gastric mucosal colonization by yeast-like micro-organisms with urease activity can account for the high frequency of false-positive results for 14C UBT.

[1]  S. Ilgan,et al.  A new, practical, low-dose 14C-urea breath test for the diagnosis of Helicobacter pylori infection: clinical validation and comparison with the standard method , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[2]  T. Massardo,et al.  Could the [14C]urea breath test be proposed as a 'gold standard' for detection of Helicobacter pylori infection ? , 2003, Medical science monitor : international medical journal of experimental and clinical research.

[3]  J. Stachura,et al.  Fungal colonization of gastric mucosa and its clinical relevance. , 2001, Medical science monitor : international medical journal of experimental and clinical research.

[4]  A. Mascarel,et al.  Diagnosis of Helicobacter pylori Infection: Noninvasive Methods Compared to Invasive Methods and Evaluation of two New Tests , 2001, American Journal of Gastroenterology.

[5]  B. Hunyady,et al.  13C-Urea breath test is superior in sensitivity to detect Helicobacter pylori infection than either antral histology or rapid urease test , 2000, Journal of Physiology-Paris.

[6]  V. Ahuja,et al.  Can the C-14 urea breath test replace follow-up endoscopic biopsies in patients treated for Helicobacter pylori infection? , 1998, Clinical nuclear medicine.

[7]  K. Krogfelt,et al.  An analysis of seven different methods to diagnose Helicobacter pylori infections. , 1998, Scandinavian journal of gastroenterology.

[8]  B. Moum,et al.  Accuracy of seven different tests for the diagnosis of Helicobacter pylori infection and the impact of H2-receptor antagonists on test results. , 1998, Scandinavian journal of gastroenterology.

[9]  G. J. Burke,et al.  Breath Test Diagnosis of Helicobacter pylori in Peptic Ulcer Disease: A Noninvasive Primary Care Option , 1997, The Journal of the American Board of Family Medicine.

[10]  M. Picard,et al.  Methodological validation and clinical usefulness of carbon-14-urea breath test for documentation of presence and eradication of Helicobacter pylori infection. , 1997, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[11]  Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. European Helicobacter Pylori Study Group. , 1997, Gut.

[12]  T. Furuta,et al.  Quantitative study of Helicobacter pylori in gastric mucus by competitive PCR using synthetic DNA fragments , 1996, Journal of clinical microbiology.

[13]  F. Mégraud.  Advantages and disadvantages of current diagnostic tests for the detection of Helicobacter pylori. , 1996, Scandinavian journal of gastroenterology. Supplement.

[14]  A. Svennerholm,et al.  A simple, rapid, and highly reliable capsule-based 14C urea breath test for diagnosis of Helicobacter pylori infection. , 1995, Scandinavian journal of gastroenterology.

[15]  M. Blaser,et al.  Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. , 1995, Gastroenterology.

[16]  J. Savino,et al.  Routine prophylactic antifungal agents (clotrimazole, ketoconazole, and nystatin) in nontransplant/nonburned critically ill surgical and trauma patients. , 1994, The Journal of trauma.

[17]  P. Sipponen,et al.  Role of Helicobacter pylori in the pathogenesis of gastritis, peptic ulcer and gastric cancer. , 1993, Scandinavian journal of gastroenterology. Supplement.

[18]  J Hilden,et al.  Observer homogeneity in the histologic diagnosis of Helicobacter pylori. Latent class analysis, kappa coefficient, and repeat frequency. , 1992, Scandinavian journal of gastroenterology.

[19]  M. Phaneuf,et al.  Gastrointestinal colonization and systemic dissemination by Candida albicans and Candida tropicalis in intact and immunocompromised mice , 1992, Infection and immunity.

[20]  P. Brown,et al.  Campylobacter pylori infection in biopsy specimens of gastric antrum: laboratory diagnosis and estimation of sampling error. , 1989, Journal of clinical pathology.

[21]  A. Opekun,et al.  CAMPYLOBACTER PYLORI DETECTED NONINVASIVELY BY THE 13C-UREA BREATH TEST , 1987, The Lancet.

[22]  B. Marshall,et al.  Pyloric Campylobacter infection and gastroduodenal disease , 1985, The Medical journal of Australia.

[23]  B. Scott,et al.  Gastro-oesophageal candidiasis. , 1982, Gut.