Accuracy of Urea Breath Test Performed Immediately After Emergency Endoscopy in Peptic Ulcer Bleeding
- 184 Downloads
The aim of this work is to investigate the accuracy of the urea breath test (UBT) performed immediately after emergency endoscopy in peptic ulcer bleeding (PUB).
Urea breath test was carried out right after emergency endoscopy in patients with PUB. The accuracy of this early UBT was compared to a delayed one after hospital discharge that was considered the gold standard. Clinical and epidemiological factors were analyzed in order to study their influence on the accuracy of the early UBT.
Early UBT was collected without any complication and good acceptance from all the 74 patients included. In 53 of the patients (71.6%), a delayed UBT was obtained. Comparing concordance between the two tests we have calculated an accuracy of 83% for the early UBT. Sensibility and specificity were 86.36 and 66%, respectively, with a positive predictive value of 92.68% and negative predictive value of 50% (Kappa index = 0.468; p = 0.0005; CI: 95%). We found no influence of epidemiological factors, clinical presentation, drugs, times to gastroscopy, Forrest classification, endoscopic therapy, hemoglobin, and urea levels over the accuracy of early UBT.
Urea breath test carried out right after emergency endoscopy in PUB is an effective, safe, and easy-to-perform procedure. The accuracy of the test is not modified by clinical or epidemiological factors, ulcer stage, or by the type of therapy applied. However, we have found a low negative predictive value for early UBT, so a delayed test is mandatory for all negative cases.
KeywordsBreath tests Endoscopy Helicobacter pylori Peptic bleeding
Conflict of interest
- 1.Mignon M, Penston JG, Deltenre M, et al. Natural history of duodenal ulcer disease: are we at a turning point? Gastroenterol Int. 1994;7:95–113.Google Scholar
- 12.Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuipers EJ. Current concepts in the management of Helicobacter pylori infection: the Maastricht III consensus report. Gut. 2007;56:772–781.Google Scholar
- 16.Calvet X, Barkun AN, Kuipers EJ, Lanas A, Bardou M, Sung JJ. Is H pylori testing clinically useful in the acute setting of upper gastrointestinal bleeding? A systematic review. Gastroenterology. 2009;136:A605.Google Scholar
- 23.Liao CC, Lee CL, Lai YC, et al. Accuracy of three diagnostic tests used alone and in combination for detecting Helicobacter pylori infection in patients with bleeding gastric ulcers. Chin Med J (Eng). 2003;116:1821–1826.Google Scholar
- 24.López Peñas D, Naranjo Rodríguez A, Muñoz Molinero J, et al. Efficacy of fecal detection of Helicobacter with the HpSA technique in patients with upper digestive hemorrhage. Gastroenterol Hepatol. 2001;2:5–8.Google Scholar
- 26.Wildner-Christensen M, Touborg Lassen A, Lindebjerg J, et al. Diagnosis of Helicobacter pylori in bleeding peptic ulcer patients, evaluation of urea-based test. Digestion. 2002;66:9–13.Google Scholar
- 28.Beyer A, Barnert J, Wienbeck M. Detection of Helicobacter pylori infection in bleeding peptic ulcers: are noninvasive tests really better? Gastroenterology. 2001;120:Suppl 1, A 99.Google Scholar
- 29.Griñó P, Pascual S, Such J, et al. Comparison of diagnostic methods for Helicobacter pylori infection in patients with upper gastrointestinal bleeding. Scand J Gastroenterol. 2001;12:1254–1258.Google Scholar
- 35.Peura DA. Patient information: Helicobacter pylori infection and treatment. ©2011 UpToDate®. www.uptodate.com.
- 36.Barkin A, Bardou M. Nonvariceal upper GI bleeding consensus conference group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843–857.Google Scholar
- 38.Barkun AN, Bardou M, Kuipers EJ, et al. For the International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Inter Med. 2010;152:101–113.Google Scholar
- 44.Carballo F, Martínez C, Aldaguer M, et al. H. pylori infection in Guadalajara. Prevalency and associated factors. Rev Esp Enferm Dig. 1996;87:7.Google Scholar