Simple and accurate 13C-urea breath test for detection of Helicobacter pylori in the remnant stomach after surgery

Background. The efficacy of the C-13-urea breath test (UBT) for diagnosis of Helicobacter pylori (H. pylori) infection in the remnant stomach after surgery is a matter of controversy. We report a simple and accurate method of C-1-UBT for diagnosis of H. pylori infection in the remnant stomach after gastrectomy. Methods. Eighty patients who had undergone gastrectomy with or without subsequent H. pylori eradication therapy were examined a total of 134 times for H. pylori infection by the C-1-UBT. C-1-Urea, 100 mg per test, was used in powdered form or in the form of film-coated tablets. Breath samples were collected before and 10, 20, and 3 min after ingestion. Mucosal biopsy specimens for bacterial culture and histological examination of the remnant stomach were collected endoscopically after each C-13-UBT test. Results. Factors that confounded the C-13-UBT results in the remnant stomach were oral bacteria, posture, and residual food. Lying horizontally on the left side was the best position, and film-coated tablets indicated no necessity for use of mouthwash. The method of anastomosis had no significant effect on the results of the C-13-UBT. Thirty minutes and a cutoff of 4.5 parts per thousand were optimal conditions for detection of H. pylori in the remnant stomach. Under these conditions, sensitivity, specificity, and accuracy were 79.4% (27/34 cases), 95.7% (44/46 cases), and 88.8% (71/80 cases), respectively, in ordinary H. pylori diagnosis, and 100% (2/2 cases), 93.3% (14/15 cases), and 94.1% (16/17 cases), respectively, in evaluating eradication at 4 weeks after treatment of H. pylori. Conclusions. Having the patient lie horizontally on the left side, using a film-coated C-13-urea tablet without using mouthwash, and measurement at 3 min provided a simple and accurate method of C-13-urea breath test for detection of H. pylori in the remnant stomach after gastrectomy.