Gastric bacterial overgrowth is a cause of false positive diagnosis of Helicobacter pylori infection using 13C urea breath test

Michaud, Laurent; Gottrand, Frédéric; Ganga-Zandzou, P.S.; Wizla-Derambure, Nathalie; Turck, Dominique; Vincent, P

doi:10.1136/gut.42.4.594a

Cited by 26 publications

(18 citation statements)

References 2 publications

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“…Antral brushing has also been used to obtain material for rapid urease testing. This procedure is inexpensive and simple, but the risk of false-positive results by urease-generating non-H. pylori bacteria has been emphasized (3,24). Further, a false-positive rate of approximately 7% for the urea breath test has been reported (20) and is reportedly due to Klebsiella pneumoniae, Proteus mirabilis, Proteus vulgaris, Morganella morganii, Providencia rettgeri, Klebsiella oxytoca, Pseudomonas aeruginosa, Yersinia enterocolitica, and Staphylococcus epidermidis (25).…”

Section: Discussionmentioning

confidence: 99%

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Use of a Combination of Brushing Technique and the Loop-Mediated Isothermal Amplification Method as a Novel, Rapid, and Safe System for Detection of Helicobacter pylori

et al. 2006

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Gastric mucosal biopsy is widely used in the detection of Helicobacter pylori but is associated with a number of problems, including false-negative results due to sampling error and massive bleeding after biopsy. Given the extended period required to culture H. pylori, detection would be further improved by the use of rapid detection methods such as PCR. Here, we developed a rapid, safe, and convenient method for collecting H. pylori which combines endoscopic brushing with the loop-mediated isothermal amplification (LAMP) method. The specificity and sensitivity of LAMP were examined using nine urease-generating non-H. pylori bacterial species, Escherichia coli, Clostridium perfringens, Campylobacter jejuni, Helicobacter hepaticus, and 51 H. pylori strains. Results showed that H. pylori-specific LAMP primers amplified H. pylori DNA only and that the lowest detection limit of the LAMP reaction was 10 2 CFU. Brushing and biopsy samples taken from 200 patients with peptic ulcer at Nagoya University Hospital and a regional health care center were subjected to both LAMP and culturing. No adverse effects such as severe bleeding or penetration occurred during the procedure. By LAMP assay, 123 patients were confirmed as H. pylori positive when brushing technique samples were assayed, whereas only 100 were positive when biopsy samples were assayed. Culture assay detected H. pylori in 117 patients when it was combined with the brushing technique and in 96 when it was combined with biopsy. Combination of the endoscopic brushing technique with LAMP is considered a useful and safe system for identifying H. pylori infection.Helicobacter pylori infection is recognized as a major cause of peptic ulcer disease and gastric cancer (8,29). H. pylori occurs beneath the mucus layer, predominantly in the antrum (34). Infection is generally confirmed by histology (21), culturing (13), and the rapid urease test (RUT) (23) performed on endoscopic gastric mucosal biopsy samples or by the urea breath test (14). This latter test is a noninvasive method that detects 13 CO 2 generated by H. pylori urease (5); because it is indirect, however, it does not allow the measurement of antibiotic susceptibility, a disadvantage given that the recent gradual increase in the number of antibiotic-resistant strains has mandated susceptibility testing before eradication therapy (9, 25). The collection and identification of strains thus remain a valuable confirmation of infection and is necessary for the investigation of virulence (12, 25).Nevertheless, biopsy carries the risk of causing bleeding and cannot be used for patients with a bleeding tendency, resulting, for example, from liver cirrhosis or idiopathic thrombocytopenic purpura, notwithstanding the possible association of these diseases with H. pylori infection (11). A second problem is the existence of urease-generating bacteria other than H. pylori; a number of bacteria produce urease and may colonize the stomach in an acid suppression environment (24, 25), potentially confounding the differentiati...

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Section: Discussionmentioning

confidence: 99%

“…A second problem is the existence of urease-generating bacteria other than H. pylori; a number of bacteria produce urease and may colonize the stomach in an acid suppression environment (24,25), potentially confounding the differentiation of H. pylori and urease-generating non-H. pylori bacteria (3).…”

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confidence: 99%

Use of a Combination of Brushing Technique and the Loop-Mediated Isothermal Amplification Method as a Novel, Rapid, and Safe System for Detection of Helicobacter pylori

et al. 2006

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“…Indeed, a further evaluation of this age group needs to be performed because false positives have been reported (228). Bacterial overgrowth could explain these false-positive results (370). Because of the change in endogenous CO 2 production due to physical activity, stress, or food consumption, a correction in endogenous CO 2 production has been proposed (263) but is not commonly employed.…”

Section: Application In Different Clinical Settingsmentioning

confidence: 99%

Helicobacter pyloriDetection and Antimicrobial Susceptibility Testing

2007

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SUMMARY The discovery of Helicobacter pylori in 1982 was the starting point of a revolution concerning the concepts and management of gastroduodenal diseases. It is now well accepted that the most common stomach disease, peptic ulcer disease, is an infectious disease, and all consensus conferences agree that the causative agent, H. pylori, must be treated with antibiotics. Furthermore, the concept emerged that this bacterium could be the trigger of various malignant diseases of the stomach, and it is now a model for chronic bacterial infections causing cancer. Most of the many different techniques involved in diagnosis of H. pylori infection are performed in clinical microbiology laboratories. The aim of this article is to review the current status of these methods and their application, highlighting the important progress which has been made in the past decade. Both invasive and noninvasive techniques will be reviewed.

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“…(Mobley & Hausinger, 1989;Murray et al, 2003). Michaud et al (1998) reported that colonization and overgrowth of urease-producing bacteria other than H. pylori induce false-positive UBT results. In a patient treated with H 2 receptor antagonists for long periods, a falsepositive result was induced by urease-producing P. mirabilis, whilst in a patient undergoing surgery for A total of 59 and 12 urease-producing bacterial strains were isolated from negative and false-positive UBT cases, respectively.…”

Section: Resultsmentioning

confidence: 99%

Urease-positive bacteria in the stomach induce a false-positive reaction in a urea breath test for diagnosis of Helicobacter pylori infection

Osaki

Mabe

Hanawa

et al. 2008

Journal of Medical Microbiology

110

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This study investigated the influence of urease-positive non-Helicobacter pylori bacteria on the results of a urea breath test (UBT) to evaluate the diagnostic utility of a UBT using film-coated [ 13 C]urea tablets. The UBT was performed in 102 patients treated with a proton pump inhibitor and antibiotics for the eradication of H. pylori. Urease-producing bacteria other than H. pylori were isolated and identified from the oral cavity and stomach. In 4/102 patients, the UBT gave false-positive results. These false-positive results were found to be caused by the presence of urease-positive bacteria in the oral cavity and stomach. Five bacterial species with urease activity (Proteus mirabilis, Citrobacter freundii, Klebsiella pneumoniae, Enterobacter cloacae and Staphylococcus aureus) were subsequently isolated from the oral cavity and/or stomach. As there was no correlation between the in vitro urease activity of urease-positive non-H. pylori bacteria and the UBT value, and all of the patients with a false-positive UBT result were suffering from atrophic gastritis, it is possible that the false-positive results in the UBT were a result of colonization of urease-positive bacteria and gastric hypochlorhydric conditions. Thus, for the diagnosis of H. pylori infection using a UBT, the influence of stomach bacteria must be considered when interpreting the results.

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Gastric bacterial overgrowth is a cause of false positive diagnosis of Helicobacter pylori infection using 13C urea breath test

Cited by 26 publications

References 2 publications

Use of a Combination of Brushing Technique and the Loop-Mediated Isothermal Amplification Method as a Novel, Rapid, and Safe System for Detection of Helicobacter pylori

Use of a Combination of Brushing Technique and the Loop-Mediated Isothermal Amplification Method as a Novel, Rapid, and Safe System for Detection of Helicobacter pylori

Helicobacter pyloriDetection and Antimicrobial Susceptibility Testing

Urease-positive bacteria in the stomach induce a false-positive reaction in a urea breath test for diagnosis of Helicobacter pylori infection

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