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ORIGINAL ARTICLE
Year : 2016  |  Volume : 39  |  Issue : 3  |  Page : 146-148  

Study on urea breath test a tool for Helicobacter pylori infection


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 Publication30-Nov-2016

Correspondence Address:
R V Kolekar
Labelled Compounds Programme, Board of Radiation and Isotope Technology, BARC Vashi Complex, Navi Mumbai - 400 705, Mumba
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0464.194958

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  Abstract 

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 27];39:146-8. Available from: https://www.rpe.org.in/text.asp?2016/39/3/146/194958


  Introduction Top


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.[1] Detection and eradication of H. pylori infection are thus an important measure to prevent these.[2]H. pylori have a worldwide prevalence rate of about 50%, with a higher prevalence in developing countries.[3] 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.[4] Furthermore, as the infection of H. pylori is patchy, the yield of biopsy-based techniques may be affected, especially in atrophic conditions.[5] UBT, an outpatient noninvasive technique achieves up to 95% sensitivity and specificity at half the cost compared to histology,[5] 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.[6],[7],[8] 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 Top


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.

Protocol

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).[7],[8] 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.
Figure 1: Principle of urea breath test

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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 Top


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.[7],[8] 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.[9],[10] 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%.[6] A study by the BRIT in Mangalore [7] 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%.[7] 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.[9] 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.[10] Similar findings were reported from Turkey, where 20–54 years had the highest prevalence, and then the authors observed a decline in the rates.[11] 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 [12] 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

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  Conclusions Top


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.

Acknowledgements

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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
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.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    
5.
Logan RP, Walker MM. ABC of the upper gastrointestinal tract: Epidemiology and diagnosis of Helicobacter pylori infection. BMJ 2001;323:920-2.  Back to cited text no. 5
    
6.
Pathak CM, Bhasin DK, Khanduja KL. Urea breath test for Helicobacter pylori detection: Present status. Trop Gastroenterol 2004;25:156-61.  Back to cited text no. 6
    
7.
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.  Back to cited text no. 7
  Medknow Journal  
8.
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.  Back to cited text no. 8
    
9.
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.  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
    
11.
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 2007;12:244-50.  Back to cited text no. 11
    
12.
Bardhan PK. Epidemiological features of Helicobacter pylori infection in developing countries. Clin Infect Dis 1997;25:973-8.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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