A capsulated microdose 14C-urea breath test (14C-UBT) was developed to detect Helicobacter pylori (HP) infection in 137 patients (54 HP negative and 83 HP positive individuals)to whom a single dose of 3. 7ｘ 104 Bq of...A capsulated microdose 14C-urea breath test (14C-UBT) was developed to detect Helicobacter pylori (HP) infection in 137 patients (54 HP negative and 83 HP positive individuals)to whom a single dose of 3. 7ｘ 104 Bq of 14C-urea in a capsule was given. Samples of exhaled gas were collected at the sib, 10th, 15th. 20th, 25th, 30th, 45th and 60th minute after the administration and the peak value of exhaled 14CO2 was found in the samples collected at the 25th minute. This peak value was taken as the measuring point and directly expressed as Bq/mmol CO2 to develop a new detecting method. Then its results were compared with those of HP culture and histological examination. It was found that the samples collected on the 25th minute showed a sensitivity of 97. 06%, specificity of 95. 12%, positive predictive value of 97. 06% and negative predictive value of 95. 12% respectively when the mean value of 14CO2 in HP negative subjects ±3s on the 25th minute was taken as the critical value. This suggests that the capsule-based microdose 14C-UBT may replace conventional 14C-UBT using a larger dose of (1. 85-3. 7)ｘ 105 Bq for it is non-invasive, safe, rapid, accurate, simple and economic.展开更多
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 we...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 rain 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.展开更多
AIM: To compare the accuracy of capsule 13C-urea breath test (UBT) with conventional invasive methods for the diagnosis of Helicobacter pylori infection.METHODS: One hundred patients received CLO test,histological exa...AIM: To compare the accuracy of capsule 13C-urea breath test (UBT) with conventional invasive methods for the diagnosis of Helicobacter pylori infection.METHODS: One hundred patients received CLO test,histological examination, culture and 100- or 50-mg capsule UBT for the diagnosis of Hpyloriinfection. Hpylori infection was defined as those with positive culture or positive results from both histology and CLO test.RESULTS: Both the sensitivity and specificity of the 100-mg capsule UBT (n = 50) were 100%. The sensitivity and specificity of the 50-mg capsule UBT (n = 50) were 96.4and 100%, respectively. Taken together, the accuracy of capsule UBT (n=100) was higher than that of CLO test,histology and culture (100% vs 92%, 91% and 89%,respectively; P= 0.035, 0.018 and 0.005, respectively). Our data showed that the optimal timing of sampling for 100-and 50-mg capsule UBT was 15-30 and 6-15 min, respectively.CONCLUSION: Capsule UBT has a higher accuracy compared with biopsy-based tests. It is an ideal method for the diagnosis of Hpyloriinfection.展开更多
AIM： To validate and compare the cost of microdose ^14C urea breath test （UBT） with histology and rapid urease test for the diagnosis of H Py/ori. METHODS： Ninety-four consecutive patients with dyspeptic symptoms ...AIM： To validate and compare the cost of microdose ^14C urea breath test （UBT） with histology and rapid urease test for the diagnosis of H Py/ori. METHODS： Ninety-four consecutive patients with dyspeptic symptoms undergoing gastroscopy were enrolled. Gastric biopsies were taken for histology and rapid urease test. UBT was performed after gastroscopy by microdose ^14 urea capsules. Sensitivity, specificity and accuracy of UBT were calculated and compared with histology and rapid urease test. Cost comparison of these tests was also performed. RESULTS： H pylori was diagnosed by histology and rapid urease test in 66 （70%） and 61 （65%） patients, while ^14C UBT detected infection in 63 （67%）. Accuracy of UBT was 93% in comparison with histology while its positive and negative predictive values were 97% and 84%, respectively. Comparison of ^14C UBT with rapid urease test gives an accuracy of 96%, with positive and negative predictive values of 95% and 97%, respectively. These results were highly reproducible with a Kappa test （P value 〈 0.001）. Cost of histology or rapid urease test with gastroscopy was 110 USD or 95 USD respectively while the cost of UBT was 15 USD.CONCLUSION： Microdose ^14C UBT was comparable to histology and rapid urease test. ^14C UBT is an economical, self sufficient and suitable test to diagnose active Hpylori infection in less developed countries.展开更多
AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) wi...AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.展开更多
AIM: To investigate whether posture affects the accuracy of 13C-urea breath test(13C-UBT) for Helicobacter pylori(H. pylori) detection in partial gastrectomy patients. METHODS: We studied 156 consecutive residual stom...AIM: To investigate whether posture affects the accuracy of 13C-urea breath test(13C-UBT) for Helicobacter pylori(H. pylori) detection in partial gastrectomy patients. METHODS: We studied 156 consecutive residual stomach patients, including 76 with H. pylori infection(infection group) and 80 without H. pylori infection(control group). H. pylori infection was confirmed if both the rapid urease test and histology were positive during gastroscopy. The two groups were divided into four subgroups according to patients' posture during the 13C-UBT: subgroup A, sitting position; subgroup B, supine position; subgroup C, right lateral recumbent position; and subgroup D, left lateral recumbent position. Each subject underwent the following modified 13C-UBT: 75 mg of 13C-urea(powder) in 100 m L of citric acid solution was administered, and a mouth wash was performed immediately; breath samples were then collected at baseline and at 5-min intervals up to 30 min while the position was maintained. Seven breathsamples were collected for each subject. The cutoff value was 2.0‰.RESULTS: The mean delta over baseline(DOB) values in the subgroups of the infection group were similar at 5 min(P > 0.05) and significantly higher than those in the corresponding control subgroups at all time points(P < 0.01). In the infection group, the mean DOB values in subgroup A were higher than those in other subgroups within 10 min and peaked at the 10-min point(12.4‰± 2.4‰). The values in subgroups B and C both reached their peaks at 15 min(B, 13.9‰± 1.5‰; C, 12.2‰± 1.7‰) and then decreased gradually until the 30-min point. In subgroup D, the value peaked at 20 min(14.7‰± 1.7‰). Significant differences were found between the values in subgroups D and B at both 25 min(t = 2.093, P = 0.043) and 30 min(t = 2.141, P = 0.039). At 30 min, the value in subgroup D was also significantly different from those in subgroups A and C(D vs C: t = 6.325, P = 0.000; D vs A: t = 5.912, P = 0.000). The mean DOB values of subjects with Billroth Ⅰ anastomosis were higher than those of subjects with Billroth Ⅱ anastomosis irrespectively of the detection time and posture(P > 0.05).CONCLUSION: Utilization of the left lateral recumbent position during the procedure and when collecting the last breath sample may improve the diagnostic accuracy of the 13C-UBT in partial gastrectomy patients.展开更多
AIM: Helicobacter pylori (H pylori) resistance after failed eradication has a major impact on the outcome of a further treatment regimen. The aim of this study was to assess the validity of a non-invasive strategy usi...AIM: Helicobacter pylori (H pylori) resistance after failed eradication has a major impact on the outcome of a further treatment regimen. The aim of this study was to assess the validity of a non-invasive strategy using the 13C-urea breath test (UBT) and the gastric string test in identifying post-treatment resistance of H pylori. METHODS: The UBT was routinely performed 4 to 6 wk after H pylori eradication therapy. Forty-two patients (24 females, 18 males, mean age 48 years) with a positive UBT were included in the study. A gastric string test using a capsule containing a 90 cm-long nylon fiber was performed. Before the capsule was swallowed, the free end of the string was taped to the cheek. After one hour in the stomach, the string was withdrawn. The distal 20 cm of the string was inoculated onto an agar plate and processed under micro-aerophilic conditions. Following the string test, upper gastrointestinal endoscopy was performed to obtain gastric biopsies for conventional culture. RESULTS: H pylori was successfully cultured from the gastric string in 34 patients (81%), but not in 5 patients due to contamination with oropharyngeal flora. H py/oriwas cultured from the gastric biopsies obtained at endoscopy in 39 patients (93%). CONCLUSION: The UBT followed by the gastric string test in the case of treatment failure is a valid diagnostic strategy with the aim of determining the post-therapeutic antibiotic resistance of H pylori with little inconvenience to the patient. Upper Gl-endoscopy can be avoided in several cases by applying consequently this diagnostic package.展开更多
文摘A capsulated microdose 14C-urea breath test (14C-UBT) was developed to detect Helicobacter pylori (HP) infection in 137 patients (54 HP negative and 83 HP positive individuals)to whom a single dose of 3. 7ｘ 104 Bq of 14C-urea in a capsule was given. Samples of exhaled gas were collected at the sib, 10th, 15th. 20th, 25th, 30th, 45th and 60th minute after the administration and the peak value of exhaled 14CO2 was found in the samples collected at the 25th minute. This peak value was taken as the measuring point and directly expressed as Bq/mmol CO2 to develop a new detecting method. Then its results were compared with those of HP culture and histological examination. It was found that the samples collected on the 25th minute showed a sensitivity of 97. 06%, specificity of 95. 12%, positive predictive value of 97. 06% and negative predictive value of 95. 12% respectively when the mean value of 14CO2 in HP negative subjects ±3s on the 25th minute was taken as the critical value. This suggests that the capsule-based microdose 14C-UBT may replace conventional 14C-UBT using a larger dose of (1. 85-3. 7)ｘ 105 Bq for it is non-invasive, safe, rapid, accurate, simple and economic.
文摘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 rain 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.
基金Supported by Grant From the National Science Council, Taiwan NSC 90-2314-B-075B-008
文摘AIM: To compare the accuracy of capsule 13C-urea breath test (UBT) with conventional invasive methods for the diagnosis of Helicobacter pylori infection.METHODS: One hundred patients received CLO test,histological examination, culture and 100- or 50-mg capsule UBT for the diagnosis of Hpyloriinfection. Hpylori infection was defined as those with positive culture or positive results from both histology and CLO test.RESULTS: Both the sensitivity and specificity of the 100-mg capsule UBT (n = 50) were 100%. The sensitivity and specificity of the 50-mg capsule UBT (n = 50) were 96.4and 100%, respectively. Taken together, the accuracy of capsule UBT (n=100) was higher than that of CLO test,histology and culture (100% vs 92%, 91% and 89%,respectively; P= 0.035, 0.018 and 0.005, respectively). Our data showed that the optimal timing of sampling for 100-and 50-mg capsule UBT was 15-30 and 6-15 min, respectively.CONCLUSION: Capsule UBT has a higher accuracy compared with biopsy-based tests. It is an ideal method for the diagnosis of Hpyloriinfection.
基金University Research Council Grant, No. 041F431YC
文摘AIM： To validate and compare the cost of microdose ^14C urea breath test （UBT） with histology and rapid urease test for the diagnosis of H Py/ori. METHODS： Ninety-four consecutive patients with dyspeptic symptoms undergoing gastroscopy were enrolled. Gastric biopsies were taken for histology and rapid urease test. UBT was performed after gastroscopy by microdose ^14 urea capsules. Sensitivity, specificity and accuracy of UBT were calculated and compared with histology and rapid urease test. Cost comparison of these tests was also performed. RESULTS： H pylori was diagnosed by histology and rapid urease test in 66 （70%） and 61 （65%） patients, while ^14C UBT detected infection in 63 （67%）. Accuracy of UBT was 93% in comparison with histology while its positive and negative predictive values were 97% and 84%, respectively. Comparison of ^14C UBT with rapid urease test gives an accuracy of 96%, with positive and negative predictive values of 95% and 97%, respectively. These results were highly reproducible with a Kappa test （P value 〈 0.001）. Cost of histology or rapid urease test with gastroscopy was 110 USD or 95 USD respectively while the cost of UBT was 15 USD.CONCLUSION： Microdose ^14C UBT was comparable to histology and rapid urease test. ^14C UBT is an economical, self sufficient and suitable test to diagnose active Hpylori infection in less developed countries.
文摘AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.
基金Supported by The Guidance Project of Science and Technology Commission of Shanghai MunicipalityNo.134119a1700+5 种基金the Appropriate Project of Shanghai Municipal Health BureauNo.2013SY049Shanghai Key Laboratory of Clinical Geriatric MedicineNo.13DZ2260700the Scientific Research Projects of Shanghai Municipal Health BureauNo.20134377
文摘AIM: To investigate whether posture affects the accuracy of 13C-urea breath test(13C-UBT) for Helicobacter pylori(H. pylori) detection in partial gastrectomy patients. METHODS: We studied 156 consecutive residual stomach patients, including 76 with H. pylori infection(infection group) and 80 without H. pylori infection(control group). H. pylori infection was confirmed if both the rapid urease test and histology were positive during gastroscopy. The two groups were divided into four subgroups according to patients' posture during the 13C-UBT: subgroup A, sitting position; subgroup B, supine position; subgroup C, right lateral recumbent position; and subgroup D, left lateral recumbent position. Each subject underwent the following modified 13C-UBT: 75 mg of 13C-urea(powder) in 100 m L of citric acid solution was administered, and a mouth wash was performed immediately; breath samples were then collected at baseline and at 5-min intervals up to 30 min while the position was maintained. Seven breathsamples were collected for each subject. The cutoff value was 2.0‰.RESULTS: The mean delta over baseline(DOB) values in the subgroups of the infection group were similar at 5 min(P > 0.05) and significantly higher than those in the corresponding control subgroups at all time points(P < 0.01). In the infection group, the mean DOB values in subgroup A were higher than those in other subgroups within 10 min and peaked at the 10-min point(12.4‰± 2.4‰). The values in subgroups B and C both reached their peaks at 15 min(B, 13.9‰± 1.5‰; C, 12.2‰± 1.7‰) and then decreased gradually until the 30-min point. In subgroup D, the value peaked at 20 min(14.7‰± 1.7‰). Significant differences were found between the values in subgroups D and B at both 25 min(t = 2.093, P = 0.043) and 30 min(t = 2.141, P = 0.039). At 30 min, the value in subgroup D was also significantly different from those in subgroups A and C(D vs C: t = 6.325, P = 0.000; D vs A: t = 5.912, P = 0.000). The mean DOB values of subjects with Billroth Ⅰ anastomosis were higher than those of subjects with Billroth Ⅱ anastomosis irrespectively of the detection time and posture(P > 0.05).CONCLUSION: Utilization of the left lateral recumbent position during the procedure and when collecting the last breath sample may improve the diagnostic accuracy of the 13C-UBT in partial gastrectomy patients.
文摘AIM: Helicobacter pylori (H pylori) resistance after failed eradication has a major impact on the outcome of a further treatment regimen. The aim of this study was to assess the validity of a non-invasive strategy using the 13C-urea breath test (UBT) and the gastric string test in identifying post-treatment resistance of H pylori. METHODS: The UBT was routinely performed 4 to 6 wk after H pylori eradication therapy. Forty-two patients (24 females, 18 males, mean age 48 years) with a positive UBT were included in the study. A gastric string test using a capsule containing a 90 cm-long nylon fiber was performed. Before the capsule was swallowed, the free end of the string was taped to the cheek. After one hour in the stomach, the string was withdrawn. The distal 20 cm of the string was inoculated onto an agar plate and processed under micro-aerophilic conditions. Following the string test, upper gastrointestinal endoscopy was performed to obtain gastric biopsies for conventional culture. RESULTS: H pylori was successfully cultured from the gastric string in 34 patients (81%), but not in 5 patients due to contamination with oropharyngeal flora. H py/oriwas cultured from the gastric biopsies obtained at endoscopy in 39 patients (93%). CONCLUSION: The UBT followed by the gastric string test in the case of treatment failure is a valid diagnostic strategy with the aim of determining the post-therapeutic antibiotic resistance of H pylori with little inconvenience to the patient. Upper Gl-endoscopy can be avoided in several cases by applying consequently this diagnostic package.
