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Excretion kinetics of 13C-urea breath test: influences of endogenous CO2 production and dose recovery on the diagnostic accuracy of Helicobacter pylori infection

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Abstract

We report for the first time the excretion kinetics of the percentage dose of 13C recovered/h (13C-PDR %/h) and cumulative PDR, i.e. c-PDR (%) to accomplish the highest diagnostic accuracy of the 13C-urea breath test (13C-UBT) for the detection of Helicobacter pylori infection without any risk of diagnostic errors using an optical cavity-enhanced integrated cavity output spectroscopy (ICOS) method. An optimal diagnostic cut-off point for the presence of H. pylori infection was determined to be c-PDR (%) = 1.47 % at 60 min, using the receiver operating characteristic curve (ROC) analysis to overcome the “grey zone” containing false-positive and false-negative results of the 13C-UBT. The present 13C-UBT exhibited 100 % diagnostic sensitivity (true-positive rate) and 100 % specificity (true-negative rate) with an accuracy of 100 % compared with invasive endoscopy and biopsy tests. Our c-PDR (%) methodology also manifested both diagnostic positive and negative predictive values of 100 %, demonstrating excellent diagnostic accuracy. We also observed that the effect of endogenous CO2 production related to basal metabolic rates in individuals was statistically insignificant (p = 0.78) on the diagnostic accuracy. However, the presence of H. pylori infection was indicated by the profound effect of urea hydrolysis rate (UHR). Our findings suggest that the current c-PDR (%) is a valid and sufficiently robust novel approach for an accurate, specific, fast and noninvasive diagnosis of H. pylori infection, which could routinely be used for large-scale screening purposes and diagnostic assessment, i.e. for early detection and follow-up of patients.

The excretion kinetics of the 13C-urea breath test with an ICOS system is demonstrated for accurate, specific, fast and noninvasive diagnosis of H. pylori infection in the human stomach

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Acknowledgments

This work was supported by the S.N. Bose National Centre for Basic Sciences (Grant No. SNB/MP/11-12/69). The authors further acknowledge the financial support from Thematic Unit (Ref. No. DST-SR/NM/NS-09/2011). The Department of Science & Technology (DST, India) Inspire Fellowships (A. Maity and G.D. Banik) and JRF studentships from S.N. Bose Centre (S. Som and C. Ghosh) are gratefully acknowledged. M. Pradhan thanks the Department of Biotechnology (DBT, India) for the award of Rapid Grant for Young Investigators (RGYI) which was helpful at the initial stage of the breath analysis research work. The authors also thank Prof. A. K. Raychaudhuri and Dr. G. Gangopadhyay for useful discussions. We are also grateful to all volunteers who willingly participated in the present study.

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Authors and Affiliations

  1. Department of Chemical, Biological and Macromolecular Sciences, S.N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, 700098, India

    Suman Som, Abhijit Maity, Gourab Dutta Banik, Chiranjit Ghosh & Manik Pradhan

  2. Department of Gastroenterology, AMRI Hospital, Salt Lake City, JC-16 & 17, Kolkata, 700098, India

    Sujit Chaudhuri & Sunil Baran Daschakraborty

  3. Department of Medicine, Vivekananda Institute of Medical Sciences, 99 Sarat Bose Road, Kolkata, 700027, India

    Shibendu Ghosh

  4. Thematic Unit of Excellence on Nanodevice Technology, S.N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, 700098, India

    Manik Pradhan

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  1. Suman Som
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  2. Abhijit Maity
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  3. Gourab Dutta Banik
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  4. Chiranjit Ghosh
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  5. Sujit Chaudhuri
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  6. Sunil Baran Daschakraborty
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  7. Shibendu Ghosh
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  8. Manik Pradhan
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Correspondence to Manik Pradhan.

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Suman Som and Abhijit Maity contributed equally to this work and are considered as joint first authors.

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Som, S., Maity, A., Banik, G.D. et al. Excretion kinetics of 13C-urea breath test: influences of endogenous CO2 production and dose recovery on the diagnostic accuracy of Helicobacter pylori infection. Anal Bioanal Chem 406, 5405–5412 (2014). https://doi.org/10.1007/s00216-014-7951-0

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  • DOI: https://doi.org/10.1007/s00216-014-7951-0

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