The ¹³carbon urea breath test for the diagnosis of Helicobacter pylori infection in subjects with atrophic gastritis: Evaluation in a primary care setting

Background: ¹³Carbon urea breath testing is reliable to detect current infection with Helicobacter pylori but has been reported to be of limited value in selected patients with atrophic body gastritis or acid-lowering medication. Aim: To evaluate the accuracy of ¹³carbon urea breath testing for H. pylori detection in 20 asymptomatic patients with histologically confirmed atrophic body gastritis in a primary care setting. Methods: ¹³Carbon urea breath testing and serology were compared with H. pylori culture of a corpus biopsy as reference test. Results: All tests were in agreement in 12 patients, being all positive in six and all negative in six. One patient was positive for serology and culture but negative for ¹³carbon urea breath testing, five patients had only positive serology and two patients had only positive ¹³carbon urea breath testing. ¹³Carbon urea breath testing showed an accuracy with culture of 85% and anti-H. pylori serology with culture of 75%. ¹³Carbon urea breath testing carried out in patients with positive serology showed an accuracy of 92%. Receiver operating characteristic curve analysis of ¹³carbon urea breath testing shows optimal discrimination at the prescribed cut-off value. Conclusions: ¹³Carbon urea breath testing can be used as diagnostic H. pylori test in asymptomatic patients with atrophic body gastritis, preferably in addition to serology, to select subjects for anti-H. pylori therapy.