Skip to main content
SpringerLink
Log in

Quantifying Gastric Helicobacter pylori Infection: A Comparison of Quantitative Culture, Urease Breath Testing, and Histology

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Although there are several methods to detect Helicobacter pylori infection, there is no simple validated test to quantify the density of infection, which is believed to play a major role in the pathogenesis of H. pylori-associated gastritis and peptic ulceration. The aim of this study was to evaluate and compare noninvasive and invasive tests for assessing the level of H. pylori infection so as to facilitate the development and clinical testing of new antibiotic treatments. Healthy volunteers (n=323) were screened for H. pylori infection by serology and, if positive (n=86), invited to undergo 13C urea breath testing (UBT) (n=55). An increase of >2.4 parts per thousand 13CO2 at 15 min compared to baseline was considered a positive test. Total cumulative urease activity (μmol) at 60 min was also calculated. UBT-positive subjects underwent endoscopy and nine biopsies were obtained from defined sites for quantitative culture and histological grading using the modified Sydney System. A total of 19 subjects were studied, 4 of whom underwent repeat testing. All subjects were positive for H. pylori by serology, UBT, culture, and histology. The increase in 13CO2 at 30 min correlated with the total cumulative urease activity at 60 min (r 2=0.92, P< 0.0001). Bacterial counts (log cfu/biopsy; mean±SD) were 3.9±0.5, 3.9±0.4, and 3.9±0.6 at the lesser curve antrum, greater curve antrum, and corpus, respectively. There was no significant correlation between UBT results and bacterial counts at any biopsy site. Nor was there any significant correlation between the histology grading and either the UBT or the bacterial counts at any site. This study indicates that there is little correlation among the three methods used to measure bacterial burden in H. pylori infection. Thus, decrements in bacterial numbers during single-agent therapy cannot be measured reliably by UBT and therefore cannot be used to evaluate the potential efficacy of novel agents to treat gastric H. pylori infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Graham DY, Lew GM, Klien PD, et al. (1992) Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric and duodenal ulcer. Ann Intern Med 116:705–708

    PubMed  CAS  Google Scholar 

  2. Bayerdorfer E, Neubauer A, Rudolph B, et al. (1995) Regression of primary gastric lymphoma of mucosa- associated lymphoid tissue after cure of Helicobacter pylori infection. Lancet 345:1591–1594

    Article  Google Scholar 

  3. Wong BC, Lam SK, Wong WM, Chen JS, Zheng TT, Feng RE, Lai KC, Hu WH, Yuen ST (2004) Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 291(2):187–194

    Article  PubMed  CAS  Google Scholar 

  4. Poon SK, Chang CS, Su J, et al. (2002) Primary resistance to antibiotics and its clinical impact on the efficacy of Helicobacter pylori lansoprazole-based triple therapies. Aliment Pharmacol Ther 16(2):291–296

    Article  PubMed  CAS  Google Scholar 

  5. Michetti P, Kreiss C, Kotloff KL, et al. (1999) Oral immunization with urease and Escherichia coli heat- labile enterotoxin is safe and immunogenic in Helicobacter pylori-infected adults. Gastroenterology 116:804–812

    Article  PubMed  CAS  Google Scholar 

  6. Hilker E, Domschke W, Stoll (1996) 13C-urea breath test for detection of Helicobacter pylori and its correlation with endoscopic and histologic findings. J Physiol Pharmacol 47:79–90

    PubMed  CAS  Google Scholar 

  7. Logan RPH, Polson RJ, Misiewicz JJ, et al. (1991) Simplified single sample 13carbon urea breath test for Helicobacter pylori: comparision with histology, culture and ELISA serology. Gut 32:1461–1464

    PubMed  CAS  Google Scholar 

  8. Sheu B-S, Lee S-C, Yang H-B, et al. (1999) Quantitative result of 13C urea breath test at 15 min may correlate with the bacterial density of H. pylori in the stomach. Hepatogastroenterology 46:2057–2062

    PubMed  CAS  Google Scholar 

  9. Ellenrieder V, Glasbrenner B, Stoffels C, et al. (1997) Qualitative and semi-quantitative value of a modified 13C-urea breath test for identification of Helicobacter pylori infection. Eur J Gastroenterol Hepatol 9:1085–1089

    PubMed  CAS  Google Scholar 

  10. Perri F, Clemente R, Pastore M, et al. (1998) The 13 C-urea breath test as a predictor of intragastric bacterial load and severity of Helicobacter pylori gastritis. Scand J Clin Lab Invest 58:19–28

    Article  PubMed  CAS  Google Scholar 

  11. Labenz J, Borsch G, Peitz U, et al. (1996) Validity of a novel biopsy urease test (HUT) and a simplified 13C-urea breath test for diagnosis of Helicobacter pylori infection and estimation of the severity of gastritis. Digestion 57:391–397

    Article  PubMed  CAS  Google Scholar 

  12. Akada JK, Shirai M, Fujii K, et al. (1999) In vitro anti-Helicobacter pylori activities of new rifamycin derivatives, KRM- 1648 and KRM-1657. Antimicrob Agents Chemother 42:1072–1076

    Google Scholar 

  13. Dixon MF, Genta RM, Yardley JH, et al. (1996) Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 20:1161–1181

    Article  PubMed  CAS  Google Scholar 

  14. Kobayashi D, Eishi Y, Ohkusa T, et al. (2002) Gastric mucosal density of Helicobacter pylori estimated by real- time PCR compared with results of urea breath test and histological grading. Diagn Microbiol 51:305–311

    CAS  Google Scholar 

  15. Chang M, Chang Y, Sun T, et al. (2002) Quantitative correlation of Helicobacter pylori stool antigen (HpSA) test with 13C-urea breath test by the updated Sydney System of gastritis. Hepatogastroenterology Mar–Apr 49(44):576–579

    Google Scholar 

  16. Moshkowitz M, Konikoff FM, Peled Y, et al. (1995) High Helicobacter pylori numbers are associated with low eradication rate after triple therapy. Gut 36:845– 847

    PubMed  CAS  Google Scholar 

  17. Sheu B-S, Yang H-B, Su I-J, et al. (1996) Bacterial density of Helicobacter pylori predicts the success of triple therapy in bleeding duodenal ulcer. Gastrointest Endosc 44:683–688

    Article  PubMed  CAS  Google Scholar 

  18. Atherton JC, Tham KT, Peek RM, et al. (1996) Density of Helicobacter pylori infection in vivo as assessed by quantitative culture and histology. J Infect Dis 27:35–41

    Google Scholar 

  19. Lewis JD, Kroser J, Beven J, et al. (1997) Urease-based tests for Helicobacter pylori gastritis—accurate for diagnosis but poor correlation with disease severity. J Clin Gastroenterol 25:415–420

    Article  PubMed  CAS  Google Scholar 

  20. Matthews GM, Cummins AG, Lawrence A, et al. (2005) 13C-Urea breath test: reproducibility and association with the severity of Helicobacter pylori-associated antral gastritis. J Gastroenterol Hepatol 20:270–274

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was funded by ActivBiotics, Lexington, Massachusetts.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Sanjeev Tummala, Sunil G. Sheth & Ciarán P. Kelly

  2. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Jeffrey D. Goldsmith & Atoussa Goldar-Najafi

  3. ActivBiotics, Lexington, Massachusetts, USA

    Christopher K. Murphy, Marcia S. Osburne, Steven Mullin & Debra Buxton

  4. Metabolic Solutions, Nashua, New Hampshire, USA

    David A. Wagner

  5. Division of Gastroenterology, Dana 601, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts, 02215, USA

    Ciarán P. Kelly

Authors
  1. Sanjeev Tummala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunil G. Sheth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey D. Goldsmith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atoussa Goldar-Najafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher K. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcia S. Osburne
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven Mullin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Debra Buxton
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David A. Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ciarán P. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ciarán P. Kelly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tummala, S., Sheth, S.G., Goldsmith, J.D. et al. Quantifying Gastric Helicobacter pylori Infection: A Comparison of Quantitative Culture, Urease Breath Testing, and Histology. Dig Dis Sci 52, 396–401 (2007). https://doi.org/10.1007/s10620-006-9377-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9377-9

Keywords

Search

Navigation