Digestive Diseases and Sciences

, Volume 57, Issue 7, pp 1880–1886 | Cite as

Accuracy of Urea Breath Test Performed Immediately After Emergency Endoscopy in Peptic Ulcer Bleeding

  • Benito Velayos
  • Luis Fernández-Salazar
  • Fernando Pons-Renedo
  • María F. Muñoz
  • Ana Almaraz
  • Rocío Aller
  • Lourdes Ruíz
  • Lourdes Del Olmo
  • Javier P. Gisbert
  • José M. González-Hernández
Original Article

Abstract

Aims

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Breath tests Endoscopy Helicobacter pylori Peptic bleeding 

Notes

Conflict of interest

None.

References

  1. 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
  2. 2.
    Hui WM, Ho J, Lam SK. Pathogenetic role of Helicobacter pylori in duodenal ulcer disease. Dig Dis Sci. 1991;36:424–430.PubMedCrossRefGoogle Scholar
  3. 3.
    Gisbert JP, Khorrami S, Carballo F, et al. Meta-analysis: Helicobacter pylori eradication therapy vs antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. Aliment Pharmacol Ther. 2004;19:617–629.PubMedCrossRefGoogle Scholar
  4. 4.
    Guell M, Artigauy E, Esteve V, Sánchez-Delgado J, Junquera F, Calvet X. Usefulness of a delayed test for the diagnosis of Helicobacter pylori infection in bleeding peptic ulcer. Aliment Pharmacol Ther. 2006;23:53–59.PubMedCrossRefGoogle Scholar
  5. 5.
    Van Leerdam ME, Tytgat GN. Review article: Helicobacter pylori infection in peptic ulcer haemorrhage. Aliment Pharmacol Ther. 2002;16:66–78.PubMedCrossRefGoogle Scholar
  6. 6.
    McColl KE. The role of Helicobacter pylori eradication in the management of acute bleeding peptic ulcer. Eur J Gastroenterol Hepatol. 1995;7:753–755.PubMedGoogle Scholar
  7. 7.
    Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:848–863.PubMedCrossRefGoogle Scholar
  8. 8.
    Sánchez-Delgado J, Gené E, Suárez D, et al. Has H. pylori prevalence in bleeding peptic ulcer been underestimated? A meta-regression. Am J Gastroenterol. 2011;106:398–405.PubMedCrossRefGoogle Scholar
  9. 9.
    Thomson SG, Higgins JP. How should meta-regression analyses be undertaken and interpreted? Stat Med. 2002;21:1559–1573.CrossRefGoogle Scholar
  10. 10.
    Gisbert JP, Pajares JM. Helicobacter pylori and bleeding peptic ulcer: what is the prevalence of the infection in patients with this complication? Scand J Gastroenterol. 2003;38:2–9.PubMedGoogle Scholar
  11. 11.
    Vaira D, Menegatti M, Miglioli M. What is the role of Helicobacter pylori in complicated ulcer disease? Gastroenterology. 1997;113:S78–S84.PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Braden B, Caspary WF. Detection of Helicobacter pylori infection: when to perform which test. Ann Med. 2001;33:91–97.PubMedCrossRefGoogle Scholar
  14. 14.
    Chien-Tien T, Chia-Long L, Chi-Hwa W, et al. Comparison of invasive and noninvasive tests for detecting Helicobacter pylori infection in bleeding peptic ulcers. Gastrointest Endoscoc. 1999;49:302–306.CrossRefGoogle Scholar
  15. 15.
    Fallone CA. Detection of Helicobacter pylori infection in the setting of acute upper gastrointestinal bleeding. J Clin Gastroenterol. 2003;37:6–8.PubMedCrossRefGoogle Scholar
  16. 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
  17. 17.
    Winiarski M, Bielanski W, Plonka M, et al. The usefulness of capsulated 13C-urea breath test in diagnosis of Helicobacter pylori infection in patients with upper gastrointestinal bleeding. J Clin Gastroenterol. 2003;37:34–38.PubMedCrossRefGoogle Scholar
  18. 18.
    Braden B, Lembcke B, Kuker W, Caspary WF. 13C-breath tests: current state of the art and future directions. Dig Liver Dis. 2007;39:795–805.PubMedCrossRefGoogle Scholar
  19. 19.
    Bielanski W, Konturek SJ. New approach to the 13C-urea breath test: capsule-based modification with low-dose of 13C-urea in the diagnosis of Helicobacter pylori infection. J Physiol Pharmacol. 1996;47:545–553.PubMedGoogle Scholar
  20. 20.
    Chung IK, Hong SJ, Kim EJ, et al. What is the best method to diagnose Helicobacter pylori in bleeding peptic ulcers? A prospective trial. Korean J Intern Med. 2001;16:147–152.PubMedGoogle Scholar
  21. 21.
    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;36:1254–1258.PubMedCrossRefGoogle Scholar
  22. 22.
    Griñó P, Pascual S, Such J, et al. Comparison of stool immunoassay with standard methods for detection of Helicobacter pylori infection in patients with upper-gastrointestinal bleeding of peptic origin. Eur J Gastroenterol Hepatol. 2003;15:525–529.PubMedCrossRefGoogle Scholar
  23. 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. 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
  25. 25.
    Tu TC, Lee CL, Wu Ch, et al. Comparison of invasive and noninvasive test for detecting Helicobacter pylori infection in bleeding peptic ulcers. Gastrointest Endosc. 1999;49:302–306.PubMedCrossRefGoogle Scholar
  26. 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
  27. 27.
    Gisbert JP, González L, De Pedro A, et al. Helicobacter pylori and bleeding duodenal ulcer: prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Scand J Gastroenterol. 2001;36:717–724.PubMedCrossRefGoogle Scholar
  28. 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. 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
  30. 30.
    Gisbert JP, Olivares D, Jiménez I, Pajares JM. Long-term follow-up of 13C-urea breath test results after Helicobacter pylori eradication: frequency and significance of borderline Δ13CO2 values. Aliment Pharmacol. 2006;23:275–280.CrossRefGoogle Scholar
  31. 31.
    Gisbert JP, Pajares JM. Review article: 13C-urea breath test in the diagnosis of Helicobacter pylori infection. A critical review. Aliment Pharmacol. 2004;20:1001–1017.CrossRefGoogle Scholar
  32. 32.
    Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR. Helicobacter pylori associated gastritis and primary B-cell gastric lymphoma. Lancet. 1991;338:1175–1176.PubMedCrossRefGoogle Scholar
  33. 33.
    Calvet X, Sanchez-Delgado J, Montserrat A, et al. Accuracy of diagnostic test for Helicobacter pylori: a reappraisal. Clin Infect Dis. 2009;48:1385–1391.PubMedCrossRefGoogle Scholar
  34. 34.
    Calvet X, Lehours P, Lario S, Mégraud F. Diagnosis of Helicobacter pylori infection. Helicobacter. 2010;15:7–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Peura DA. Patient information: Helicobacter pylori infection and treatment. ©2011 UpToDate®. www.uptodate.com.
  36. 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
  37. 37.
    Hahn M, Fennerty B, Corless CL, Magaret N, Lieberman DA, Faigel DO. Noninvasive tests as a substitute for histology in the diagnosis of Helicobacter pylori infection. Gastrointestinal Endosc. 2000;52:20–26.CrossRefGoogle Scholar
  38. 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
  39. 39.
    Chey WD, Spybrook M, Carpenter S, Nostrant TT, Elta GH, Scheiman JM. Prolonged effect of omeprazole on the 14Curea breath test. Am J Gastroenterol. 1996;91:89.PubMedGoogle Scholar
  40. 40.
    Graham DY, Opekun AR, Hammoud F, et al. Studies regarding the mechanism of false negative urea breath tests with proton pump inhibitors. Am J Gastroenterol. 2003;98:1005–1009.PubMedCrossRefGoogle Scholar
  41. 41.
    Tang JH, Liu NJ, Cheng HT, et al. Endoscopic diagnosis of Helicobacter pylori infection by rapid urease test in bleeding peptic ulcers: a prospective case-control study. J Clin Gastroenterol. 2009;43:133–139.PubMedCrossRefGoogle Scholar
  42. 42.
    Colin R, Czernichow P, Baty V, et al. Low sensitivity of invasive tests for the detection of Helicobacter pylori infection in patients with bleeding ulcer. Gastroenterol Clin Biol. 2000;24:31–35.PubMedGoogle Scholar
  43. 43.
    Gisbert JP, Pajares JM. 13C-urea breath test in the management of Helicobacter pylori infection. Dig Liver Dis. 2005;37:899–906.PubMedCrossRefGoogle Scholar
  44. 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

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Benito Velayos
    • 1
    • 6
  • Luis Fernández-Salazar
    • 1
  • Fernando Pons-Renedo
    • 2
  • María F. Muñoz
    • 3
  • Ana Almaraz
    • 4
  • Rocío Aller
    • 1
  • Lourdes Ruíz
    • 1
  • Lourdes Del Olmo
    • 1
  • Javier P. Gisbert
    • 5
  • José M. González-Hernández
    • 1
  1. 1.Department of GastroenterologyHospital Clínico de ValladolidValladolidSpain
  2. 2.Department of GastroenterologyHospital Puerta de HierroMajadahonda, MadridSpain
  3. 3.Investigation UnitHospital Clínico de ValladolidValladolidSpain
  4. 4.Department of Preventive MedicineUniversidad de ValladolidValladolidSpain
  5. 5.Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa (IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)Hospital Universitario de La PrincesaMadridSpain
  6. 6.Department of GastroenterologyUniversity Hospital of ValladolidValladolidSpain

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