Gut Liver.
2019 Sep;13(5):506-514. 10.5009/gnl18398.
Effect of Citric Acid on Accuracy of ¹³C-Urea Breath Test after Helicobacter pylori Eradication Therapy in a Region with a High Prevalence of Atrophic Gastritis
- Affiliations
-
- 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. nakim49@snu.ac.kr
- 2Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
- 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- KMID: 2458507
- DOI: http://doi.org/10.5009/gnl18398
Abstract
- BACKGROUND/AIMS
The validity of ¹³C-urea breath test (¹³C-UBT) for Helicobacter pylori detection is influenced by atrophic gastritis. The aim of this study was to evaluate the effect of citric acid on the accuracy of ¹³C-Urea breath test after H. pylori eradication therapy in a region where atrophic gastritis is common.
METHODS
In this prospective study, H. pylori-positive patients received ¹³C-UBT after H. pylori eradication regimen. They were classified into citric acid group and control group. To determine diagnostic accuracy of ¹³C-UBT, patients were offered invasive methods.
RESULTS
A total of 1,207 who successfully took H. pylori-eradication regimen received UBT. They were assigned into the citric acid group (n=562) and the control group (n=645). The mean ¹³C-UBT value of the citric acid group was 10.3±26.4"°, which was significantly (p<0.001) higher than that of that control group (5.1"°±12.6"°). Of these patients 122 patients were evaluated by endoscopic biopsy methods. Based on invasive tests, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ¹³C-UBT for the citric acid group were 83.3%, 91.7%, 81.3%, 55.0%, and 97.5%, respectively. Those of the control group were 87.7%, 90.9%, 88.2%, 62.5%, and 97.8%, respectively. They were not significantly different between the two groups. Although the presence of gastric atrophy and intestinal metaplasia (IM) decreased the accuracy, the decrease was not significant.
CONCLUSIONS
In a country with high prevalence of atrophic gastritis or IM, false positivity remained common despite the use of citric acid in ¹³C-UBT.
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