|Year : 2016 | Volume
| Issue : 3 | Page : 146-148
Study on urea breath test a tool for Helicobacter pylori infection
RV Kolekar1, Anita Gadgil2, S. P. D. Bhade1, Priyanka Reddy1, Prashant Bhandarkar2, N Roy2, SP Patil3, Rajvir Singh1
1 Radiation Safety Systems Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
2 Medical Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
3 Labelled Compounds Programme, Board of Radiation and Isotope Technology, Navi Mumbai, Maharashtra, India
|Date of Web Publication||30-Nov-2016|
R V Kolekar
Labelled Compounds Programme, Board of Radiation and Isotope Technology, BARC Vashi Complex, Navi Mumbai - 400 705, Mumba
Source of Support: None, Conflict of Interest: None
Urea breath test (UBT) is commonly used diagnostic test for detecting the presence of Helicobacter pylori bacteria in the stomach. The patient undergoing the UBT ingests one microcurie of urea capsule containing labeled carbon-14. After ingestion of the capsule, the patient blows into a trapping solution. H. pylori bacteria in the stomach releases enzyme urease which breaks urea capsule to release carbon dioxide tagged with carbon-14 in the exhaled breath. Carbon-14 in the trapping solution is counted in liquid scintillation counter. In this study, 261 patients suspected of H. pylori infection had undergone UBT. It was found that 52% of the patients tested positive for H. pylori infection. No significant difference observed between various age groups. There was no statistically significant difference between the infection rates in males and females.
Keywords: Helicobacter pylori, liquid scintillation, urea breath test
|How to cite this article:|
Kolekar R V, Gadgil A, Bhade S, Reddy P, Bhandarkar P, Roy N, Patil S P, Singh R. Study on urea breath test a tool for Helicobacter pylori infection. Radiat Prot Environ 2016;39:146-8
|How to cite this URL:|
Kolekar R V, Gadgil A, Bhade S, Reddy P, Bhandarkar P, Roy N, Patil S P, Singh R. Study on urea breath test a tool for Helicobacter pylori infection. Radiat Prot Environ [serial online] 2016 [cited 2020 Oct 21];39:146-8. Available from: https://www.rpe.org.in/text.asp?2016/39/3/146/194958
| Introduction|| |
Helicobacter pylori commonly called as H. pylori reside in the gastric epithelial mucosa and induce an inflammatory response leading to gastritis, peptic ulcer disease, and gastric malignancies. Detection and eradication of H. pylori infection are thus an important measure to prevent these.H. pylori have a worldwide prevalence rate of about 50%, with a higher prevalence in developing countries. The techniques to detect H. pylori infections are divided into invasive and noninvasive based on whether endoscopy is required or not. Invasive tests offer the possibility of obtaining tissue samples, which can be used for a rapid urease test, culture, polymerase chain reaction, and histopathology evaluation. Noninvasive tests include serum H. pylori IgG antibody titer, the urea breath test (UBT), and H. pylori stool antigen assay. Invasive techniques are however inconvenient and more costly for patients. Furthermore, as the infection of H. pylori is patchy, the yield of biopsy-based techniques may be affected, especially in atrophic conditions. UBT, an outpatient noninvasive technique achieves up to 95% sensitivity and specificity at half the cost compared to histology, in detecting H. pylori infection. Though UBT is a gold standard worldwide to detect H. pylori, Indian studies on the use of UBT and its standard protocol are sparse.,, In the present paper, application of C-14 UBT for the diagnosis of H. pylori bacterial infection in 261 adult patients in our community hospital, in Mumbai is discussed.
| Materials and Methods|| |
In this study, total 261 patients for resistant complaints of dyspepsia were included over a period of 5 years from 2010 to 2014. Dyspepsia was considered resistant to treatment after 6 weeks of therapy with proton pump inhibitors (PPI). All patients who do not respond to standard PPI treatment for 6 weeks report to this surgical gastroenterology laboratory for further diagnosis and treatment.
Patients were asked to stop all antibiotics and PPI drugs such as pantoprazole and omeprazole and bismuth containing drugs for 2 weeks before the test.
Carbon-14 labeled urea breath test as a tool
The test is based on the principle that swallowed “labeled carbon-containing urea” is broken down to ammonia and carbon dioxide (CO2) by the urease-producing microorganism (H. pylori) in the gastric mucosa and finally tagged carbon-14 within the liberated CO2 is detected in exhaled breath samples.
Urea breath test procedure
Patients suspected of H. Pylori infection received indigenously produced carbon-14 urea capsules by Board of Radiation and Isotope Technology, India (BRIT) (activity 1 microcurie)., After 10 min the patients blew into precisely titrated solution of hyamine hydroxide containing thymolphthalein blue indicator. For 5 min or till the solution turns colorless whichever is earlier. This solution traps the exhaled CO2. When sufficient CO2 is exhaled, the solution becomes acidic, and indicator changes its color to colorless solution. Now scintillator is added to the solution which is counted in ultra-low level liquid scintillation counter for carbon-14 activity for 300 min. Once carbon-14 activity is detected in the sample, it indicates the presence of H. pylori infection in the patient. The schematic sketch of the procedure is shown in [Figure 1]. All the measurements were carried in ultra-low level liquid scintillation counter (Quantulus1220, PerkinElmer) having MDA of 0.045Bq.
Data collection and analysis
Case files of the patients and the electronic records were retrieved from computerized hospital information system for the demographic details. The results were then tabulated in Excel sheet patients below 50 years of age were compared with those above 50 years for analyzing positivity of the test. Age and sex distribution of the infection was then analyzed. Minitab 16 version was used for statistical analysis.
| Results and Discussion|| |
This study has used indigenously made carbon-14 urea capsules by Board of Radiation and Isotope Technology, Mumbai, India. The use of these capsules has been validated in two of the previous studies by the board., A total of 261 patients were included in the present study. Mean age was 48.10 years (range 14–82 years). Among the total patients studied, 52% of the patients tested positive for H. pylori infection. UBT positivity was found to be declined from younger to older age groups; it was 80% for <21 year age group while 38% for >70 years. UBT was positive in 55% of the patients in younger age group (<50 years) compared to 48% in older age group (>50 years). Although this difference was not statistically significant (P = 0.32), but the fast food habits in younger age group may be one of the reasons for higher positivity compared to older age groups.
Male to female ratio in the sample was 1.5:1. Proportion of positivity of males was higher in all age groups except in age group of >70 years as shown [Figure 2]. In all the age groups, males showed higher positivity (56%) than females (46%) except in geriatric age group (>70 years) as seen in [Figure 2]. This difference in test positivity for H. pylori infection was not statistically significant between males and females (P = 0.25). Study of UBT in severely dyspeptic adult patients has not been commonly studied in Indian literature. Data published on the topic more commonly describes the use of histopathology to detect the presence of H. pylori., The positivity rates among the western populations are quoted to as low as 10% whereas in Indian and developing countries infection rates are as high as 70–80%. A study by the BRIT in Mangalore  has observed about 32.5% of the asymptomatic patients to be positive for UBT. This study has also reported 41.2% positivity among symptomatic patients, and the overall prevalence was up to 37%. In this study, we found that 52% of our patients were tested positive for H. pylori infection which is comparable with the previous literature studies. A study by Graham et al. from Hyderabad have observed up to 80% of the patients to be positive by the third decade. A study from two large hospitals in Mumbai showed that incidence was high till the fifth decade and steadily decreased up to the seventh decade. Similar findings were reported from Turkey, where 20–54 years had the highest prevalence, and then the authors observed a decline in the rates. We found that patients older than 50 years had declining rates of H. pylori infection. A review of H. pylori infection among developing countries from Bangladesh by Pradip and Bardhan  took into consideration, data from various Asian, African and Latin American countries. They observed that males and female showed similar infection rates. The paper included studies which used various methods of detection for H. pylori, including histology, serology, culture and UBT. The authors concluded that there was no significant difference between the prevalence of infections among males and females. In the present study also we observed the difference in UBT positivity in males and females was statistically insignificant.
|Figure 2: Age group and gender wise distribution of urea breath test positive patients|
Click here to view
| Conclusions|| |
In this study, we could demonstrate the trends of H. pylori infection in urban community and their distribution across age groups and genders. Among the total patients studied, 52% tested positive for H. pylori infection. Though the younger patients had higher positivity rates for H. pylori infection compared to older patients but the difference was statistically insignificant. The infection rates in males and females were also observed to be statistically insignificant. There is a need to replicate the study on larger population, including asymptomatic individuals and to determine the demographic factors that affect the infection rates of H. pylori.
The authors sincerely thank Dr. K.S. Pradeepkumar, Associate Director HS and E group, BARC. Further thanks to Dr. R. K. Kulkarni, former Head Medical Division, BARC for his support in the work. Also Thanks to Shri. Jaychandran from Board of Radiation and Isotope Technology.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sipponen P, Hyvarinen H. Role of Helicobacter pylori
in the pathogenesis of gastritis, peptic ulcer and gastric cancer. Scand J Gastroenterol 1993;28:3-6.
Feng RE, Hsing W, Hu C, Ching CK. Helicobacter pylori
eradication to prevent gastric cancer in a high risk region of China. J Am Med Assoc 2004;292:187-94.
Graham DY, Malaty HM, Evans DG, Evans DJ Jr., Klein PD, Adam E. Epidemiology of Helicobacter pylori
in an asymptomatic population in the United States. Effect of age, race, and socioeconomic status. Gastroenterology 1991;100:1495-501.
Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, et al.
Current concepts in the management of Helicobacter pylori
infection: The Maastricht III consensus report. Gut 2007;56:772-81.
Logan RP, Walker MM. ABC of the upper gastrointestinal tract: Epidemiology and diagnosis of Helicobacter pylori
infection. BMJ 2001;323:920-2.
Pathak CM, Bhasin DK, Khanduja KL. Urea breath test for Helicobacter pylori
detection: Present status. Trop Gastroenterol 2004;25:156-61.
Swaroop K, Patil SL, Somshekarappa HM. A study of Helicobacter pylori
infection using the C-14 UBT method. Radiat Prot Environ 2011;34:206-9.
Tiwari BP, Nistala S, Patil SP, Kalgutkar DP, Jaychandran N, Chander H, et al.
Evaluation of the (14) C-urea breath test using indigenously produced (14) C-urea capsules and a modified technique for trapping exhaled breath: A pilot study. Nucl Med Commun 2014;35:325-30.
Graham DY, Adam E, Reddy GT, Agarwal JP, Agarwal R, Evans DJ Jr., et al.
Seroepidemiology of Helicobacter pylori
infection in India comparison of developing and developed countries. Dig Dis Sci 1991;36:1084-8.
Gill HH, Majmudar P, Shankaran K, Desai HG. Age-related prevalence of Helicobacter pylori
antibodies in Indian subjects. Indian J Gastroenterol 1994;13:92-4.
Seyda T, Derya C, Füsun A, Meliha K. The relationship of Helicobacter pylori
positivity with age, sex, and ABO/Rhesus blood groups in patients with gastrointestinal complaints in Turkey. Helicobacter
Bardhan PK. Epidemiological features of Helicobacter pylori
infection in developing countries. Clin Infect Dis 1997;25:973-8.
[Figure 1], [Figure 2]