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Simple and accurate 13C-urea breath test for detection of Helicobacter pylori in the remnant stomach after surgery

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Abstract

Background

The efficacy of the 13C-urea breath test (UBT) for diagnosis of Helicobacter pylori (H. pylori) infection in the remnant stomach after surgery is a matter of controversy. We report a simple and accurate method of 13C-UBT for diagnosis of H. pylori infection in the remnant stomach after gastrectomy.

Methods

Eighty patients who had undergone gastrectomy with or without subsequent H. pylori eradication therapy were examined a total of 134 times for H. pylori infection by the 13C-UBT. 13C-Urea, 10mg per test, was used in powdered form or in the form of film-coated tablets. Breath samples were collected before and 10, 20, and 3min after ingestion. Mucosal biopsy specimens for bacterial culture and histological examination of the remnant stomach were collected endoscopically after each 13C-UBT test.

Results

Factors that confounded the 13C-UBT results in the remnant stomach were oral bacteria, posture, and residual food. Lying horizontally on the left side was the best position, and film-coated tablets indicated no necessity for use of mouthwash. The method of anastomosis had no significant effect on the results of the 13C-UBT. Thirty minutes and a cutoff of 4.5‰ were optimal conditions for detection of H. pylori in the remnant stomach. Under these conditions, sensitivity, specificity, and accuracy were 79.4% (27/34 cases), 95.7% (44/46 cases), and 88.8% (71/80 cases), respectively, in ordinary H. pylori diagnosis, and 100% (2/2 cases), 93.3% (14/15 cases), and 94.1% (16/17 cases), respectively, in evaluating eradication at 4 weeks after treatment of H. pylori.

Conclusions

Having the patient lie horizontally on the left side, using a film-coated 13C-urea tablet without using mouthwash, and measurement at 3min provided a simple and accurate method of 13C-urea breath test for detection of H. pylori in the remnant stomach after gastrectomy.

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Authors and Affiliations

  1. Surgery for Organ Function and Biological Regulation, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Akiyoshi Togashi, Norio Matsukura, Shunji Kato, Gotaro Masuda, Keiichi Ohkawa, Akira Tokunaga & Takashi Tajiri

  2. Integrated Pathology, Nippon Medical School, Tokyo, Japan

    Nobutaka Yamada

Authors
  1. Akiyoshi Togashi
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  2. Norio Matsukura
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  3. Shunji Kato
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  4. Gotaro Masuda
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  5. Keiichi Ohkawa
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  6. Akira Tokunaga
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  7. Nobutaka Yamada
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  8. Takashi Tajiri
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Togashi, A., Matsukura, N., Kato, S. et al. Simple and accurate 13C-urea breath test for detection of Helicobacter pylori in the remnant stomach after surgery. J Gastroenterol 41, 127–132 (2006). https://doi.org/10.1007/s00535-005-1731-8

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  • DOI: https://doi.org/10.1007/s00535-005-1731-8

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