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Case 27
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
13C urea breath testThe patient drinks a drink containing urea with a labelled carbon isotopeIf H. pylori is present the urea will be hydrolysed to ammonia and CO2, meaning that the patient will breathe out labelled CO2 after around 20 minutes which can be detected in breath samplesThis can be used both to make a diagnosis and confirm eradication post-treatment
Gastrointestinal tract and salivary glands
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
13C-urea breath test is the most sensitive diagnostic method to detect the presence of Helicobacter pylori infection in the stomach. It takes advantage of the process of metabolism from Helicobacter pylori. The bacterium will split urea into urease and carbon dioxide (CO2), this will then be exhaled. Radioactive labelled CO2 can then be detected and the infection diagnosed.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
C13, C14 urea breath tests use a similar principle as the rapid urea breath test. However, instead of measuring the pH and colour change of the test medium, the urea breath test measures the amount of CO2 excreted through exhalation. It is highly sensitive (88–95%) and specific (95–100%) [25]. The C13, C14 urea breath test requires patients to fast for at least six hours before the test. Patients drink a urea tablet/capsule labelled with C13, C14. The urease enzyme secreted by H. pylori hydrolyses urea to produce labelled CO2, which is excreted through exhalation. This amount of labelled CO2 can be measured through the exhaled breaths after 20–30 minutes of consumption of urea.
Helicobacter Pylori Related Gastric Cancer Screening and Cost-Effectiveness Analysis: A Hospital-Based Cross-Sectional Study (SIGES)
Published in Nutrition and Cancer, 2022
Wen Xiang, Rui Wang, Dan Bai, Tian-Hang Yu, Xin-Zu Chen
Helicobacter pylori (Hp) is closely related to the development of gastric cancer, which was listed as a class I carcinogen by the World Health Organization (WHO) in 1994 (23, 24). China was a country with a high infection rate of Helicobacter pylori, and the prevalence of Helicobacter pylori infection for the general population was 55.8% (25). It was reported that the infection rate of Helicobacter pylori in Chengdu, Sichuan Province was about 53.1% (26). Long-term infection of Hp can cause atrophic gastritis, a precancerous lesion, and further generate gastric cancer (27, 28). The role of Hp-related gastric cancer screening (Hp-GCS) for endoscopy candidates has been reported in a large number of literature studies (29, 30). Iris, et al. pointed out that due to the low cost of screening test, Hp-GCS had certain cost-effectiveness value (31). For the diagnosis of Hp, urea breath test (UBT) has relatively high sensitivity and specificity, with low cost (32). Therefore, this study was aimed to identify the diagnostic strength of UBT for gastric cancer and the cost-effectiveness of Hp-GCS.
Perforation of the excluded segment without pneumoperitoneum following Roux-en-Y gastric bypass surgery: case report and literature review
Published in Acta Chirurgica Belgica, 2021
Maxime Peetermans, Jana Vellemans, Guido Jutten, Pieter D’hooge, Peter Delvaux, Frederik Huysentruyt, Anneleen Van Hootegem, Jos Callens, Olivier Peetermans
Several mechanisms have been proposed to explain the pathophysiology of (perforated) ulcers of the excluded segment. H. pylori remains an important risk factor in the development of ulcers in RYGB patients due to weakness of the mucosal barriers [32]. In the case we present, biopsies taken during the preoperative work-up of the original RYGB surgery were negative for H. pylori. Nevertheless, the literature shows that biopsies of the excluded stomach of RYGB patients could be positive for H. pylori, despite negative preoperative biopsies [33,34]. Therefore, H. pylori serology was performed, which proved to be negative as well. H. pylori stool antigen test and urea breath test were not performed since the patient was still taking proton pump inhibitors. Furthermore, the urea breath test is not useful in RYGB patients since the urea does not reach the excluded segment [11]. An isolated H. pylori infection of the excluded stomach has never been reported in the literature as it was always accompanied by an infection of the functional, proximal stomach [34]. However, there is no general consensus regarding the detection of H. pylori in the excluded stomach. Additional studies are necessary.
Treatment of Helicobacter pylori with nitazoxanide-containing regimens: a systematic review
Published in Infectious Diseases, 2020
Sukdong Lee, Gregory T. Sneed, Jamie N. Brown
Ramos-Soriano et al. conducted a retrospective cohort study of 111 paediatric patients aged 1–21 to evaluate empiric treatment with nitazoxanide for 3 days in combination with cefixime, ceftibuten or cefdinir and azithromycin for 7–10 days and a PPI for 30 days. Paediatric patients included in the study were required to have chronic abdominal pain, chronic nausea or vomiting, and other GI-related conditions, in addition to an endoscopy and a diagnosis for H. pylori. Patients were excluded if they failed to return for follow-up, had incomplete information within the chart, or had persistent or recurrence of infection within 4 months of initiation of the original drug therapy. Patients were assessed for clinical cure with a negative urea breath test and being symptom-free up to 4 months after the initiation of the therapeutic intervention. The rates of cure were 89.2% and a total of 10% of the patients experienced minor GI side effects, which were determined to be mild-to-moderate severity. All 12 patients with clinical failures reported mild-to-moderate abdominal pain, nausea and/or vomiting during the study time-frame and one patient also experienced a facial rash [20].