Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection

Buzás, György Miklós; Széles, Ilona

doi:10.1007/s00535-007-2135-8

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…It would be possible to combine inhaled labeled urea in humans (to drive lung specificity of tracer delivery) with an oral therapy that includes inhibitors of Helicobacter urease, such as bismuth salts (i.e. Pepto-Bismol®) or proton pump inhibitors or lithostat to suppress GI urease activity and possible confounding of data [40], [41]. An additional approach would be to co-administer a urea drink (similar to the Breathtek approach for H. pylori ) that is not enriched in 13 C, but rather has this at normal abundance: therefore any CO 2 produced by gut organisms would not be enriched in 13 CO 2 and thus not confound the signal from the lungs.…”

Section: Discussionmentioning

confidence: 99%

13[C]-Urea Breath Test as a Novel Point-of-Care Biomarker for Tuberculosis Treatment and Diagnosis

et al. 2010

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BackgroundPathogen-specific metabolic pathways may be detected by breath tests based on introduction of stable isotopically-labeled substrates and detection of labeled products in exhaled breath using portable infrared spectrometers.Methodology/Principal FindingsWe tested whether mycobacterial urease activity could be utilized in such a breath test format as the basis of a novel biomarker and diagnostic for pulmonary TB. Sensitized New-Zealand White Rabbits underwent bronchoscopic infection with either Mycobacterium bovis or Mycobacterium tuberculosis. Rabbits were treated with 25 mg/kg of isoniazid (INH) approximately 2 months after infection when significant cavitary lung pathology was present. [13C] urea was instilled directly into the lungs of intubated rabbits at selected time points, exhaled air samples analyzed, and the kinetics of δ13CO2 formation were determined. Samples obtained prior to inoculation served as control samples for background 13CO2 conversion in the rabbit model. 13CO2, from metabolic conversion of [13C]-urea by mycobacterial urease activity, was readily detectable in the exhaled breath of infected rabbits within 15 minutes of administration. Analyses showed a rapid increase in the rate of 13CO2 formation both early in disease and prior to treatment with INH. Following INH treatment, all evaluable rabbits showed a decrease in the rate of 13CO2 formation.Conclusions/SignificanceUrea breath testing may provide a useful diagnostic and biomarker assay for tuberculosis and for treatment response. Future work will test specificity for M. tuberculosis using lung-targeted dry powder inhalation formulations, combined with co-administering oral urease inhibitors together with a saturating oral dose of unlabeled urea, which would prevent the δ13CO2 signal from urease-positive gastrointestinal organisms.

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Section: Discussionmentioning

confidence: 99%

13[C]-Urea Breath Test as a Novel Point-of-Care Biomarker for Tuberculosis Treatment and Diagnosis

et al. 2010

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“…An attempt to correlate delta over baseline (DOB) values with the outcome of eradication therapy was made in Italy [34] but found no significant difference in DOB values by treatment outcome or by the antibiotic resistance pattern to clarithromycin. The predictive value of 13 C‐UBT in the choice of second‐ and third‐line eradication therapy was explored in 134 duodenal ulcer patients with a failed first eradication therapy, finding a negative correlation between 13 C‐UBT values and outcome both in the second‐ and the third‐line treatments [35]. A meta‐analysis of H. pylori recurrence after eradication identified ten valid studies from developed countries and seven from developing countries that used 13 C‐UBT for follow up [36].…”

Section: Noninvasive Methodsmentioning

confidence: 99%

Diagnosis of Helicobacter pylori

et al. 2008

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The different invasive and noninvasive diagnostic tests for Helicobacter pylori have been applied mainly in emerging countries. Molecular methods have been developed, especially a test for detection of H. pylori and its clarithromycin resistance directly from stools. The long-term effects of eradication on histologic lesions have been studied in a meta-analysis and the prognostic value of post-treatment in gastric mucosa-associated lymphoid tissue lymphoma has been assessed. An operating link for gastritis assessment (the OLGA staging) has also been published. Attempts to simplify the urea breath test protocol have been made, and new stool antigen tests have been proposed and compared to those previously available.

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“…They found as in previous studies that higher pretreatment UBT values were associated with lower eradication rates but interestingly, they also showed a marked tendency to increase UBT values for the patients who failed, i.e. from 13.2‰ (CI: 7.3–19.1) to 19.2‰ (CI: 13.4–25.0) after second‐line therapy and to 25.8‰ (CI: 19.8–31.2) after third‐line therapy, but they could not explain this phenomenon [15]. In another study, UBT values were also found to be higher when clarithromycin resistant H. pylori were present, but not when other resistances occurred [16].…”

Section: Non‐molecular Methodsmentioning

confidence: 99%

Diagnosis of Helicobacter pylori Infection

et al. 2009

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The articles published this last year in the field of Helicobacter pylori diagnosis reported the development of in vivo histology, small improvements in some invasive methods (urease test, culture, and histology) and new kits for the stool antigen tests. They also contributed to increasing our knowledge, by further exploration into specific conditions for the urea breath test and into the significance of cagA antibodies. The role of serum markers of atrophy was also confirmed. Molecular methods are still being developed for direct genotyping, detection of H. pylori and its clarithromycin resistance, either by polymerase chain reaction or fluorescent in-situ hybridization. For the first time, there was a report on a possible interest of magnetic resonance spectroscopy.

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Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection

Cited by 8 publications

References 32 publications

13[C]-Urea Breath Test as a Novel Point-of-Care Biomarker for Tuberculosis Treatment and Diagnosis

13[C]-Urea Breath Test as a Novel Point-of-Care Biomarker for Tuberculosis Treatment and Diagnosis

Diagnosis of Helicobacter pylori

Diagnosis of Helicobacter pylori Infection

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