In the present issue of Endoscopy, Fruehauf et al. [1] report the results of a study comparing the gastroscopic real−time 13 C−urea breath test with the rapid urease test.Since the recognition of the pathophysiological role of Helicobac− ter pylori in peptic ulcer diseases, gastric carcinoma and mucosa− associated lymphoid tissue lymphoma, hundreds of articles have been published on H. pylori tests. H. pylori infection can be de− tected by invasive and noninvasive methods. It can be recognized in gastric mucosa specimens, in feces, in urine, and in blood. Sev− eral test methods are available for research and clinical purposes, including: histological staining, microbiological culture, poly− merase chain reaction, enzyme−linked immunoabsorbent assay, immunoblotting, and urease−based tests [2,3]. For clinical pur− poses, the noninvasive 13 C breath test and biopsy−based rapid ur− ease test are the ones most frequently used. Today, these two tests are highly sensitive (86±98 %) and specific (90 ± 100 %); they are easy to carry out and are relatively inexpensive.Before taking a critical look at the above−mentioned paper, we should ask whether there is actually any need for new clinical H. pylori tests, and what requirements new tests would have to meet in order to make them superior to the older tests. To achieve improved sensitivity and specificity is not easy to ac− complish, as the sensitivity and the specificity of the available tests are already quite high. One primary goal would be the de− velopment of a reliable H. pylori test that would detect infection in patients receiving antisecretory therapy, or in the presence of blood in the stomach. Another goal might be to develop tests that are cheaper, more convenient, and faster than the available ones. All of these aspects need to be taken into account in discussing the paper on gastroscopic breath testing by Fruehauf et al. [1].In a prospective, randomized, and controlled study, Fruehauf and colleagues investigated the feasibility of H. pylori breath tests during gastroscopy and compared this procedure with the rapid urease test. The validated sensitivity and specificity of the gas− troscopic breath test (GBT) were 97.8 % and 96.1 %, respectively. The gastroscopic 13 C breath test was carried out during upper gastrointestinal endoscopy. After inspection of the gastric muco− sa, the 13 C−urea solution was injected into the stomach through the scope. Breath samples, aspirated via a nasal cannula, were continuously analyzed using molecular correlation spectroscopy. The result of the GBT was available after a mean of 14 min, com− pared with 19 h for the rapid urease test. Gastroscopy with GBT took slightly longer to perform and prolonged the occupancy of the endoscopy room by 5 ± 6 min in comparison with rapid ur− ease testing. The authors emphasize that GBT is a noninvasive test and can be used without risks in patients with bleeding dis− orders, those receiving anticoagulation therapy, those taking nonsteroidal anti−inflammatory drugs (NSAIDs), and in patients la...
