Lower-dose (13)C-urea breath test to detect Helicobacter pylori infection-comparison between infrared spectrometer and mass spectrometry analysis

Abstract

Background: The expense of the (13)C-urea breath test (UBT) to detect Helicobacter pylori infection is mainly due to the cost of (13)C-urea and the analysis using isotope ratio mass spectrometry (IRMS).

Aim: To test whether a UBT, using a lower dose of urea and lower-priced isotope-selective nondispersive infrared spectrometry (INIS), can preserve diagnostic efficacy in clinical practice.

Methods: A total of 177 dyspeptic patients received endoscopy for H. pylori culture and histology. All of them received a UBT in which the duplicate baseline, 10 min, and 15 min breath samples after ingestion of 50 mg (13)C-urea were collected to analyse the excess (13)CO(2)/(12)CO(2) ratio (ECR) by IRMS (ABCA, Europa Scientific, UK) and INIS (UBiT-IR200, Photal Otsuka Electronics, Japan), respectively.

Results: Of the 177 patients, 84 were infected and 93 were uninfected with H. pylori. A close correlation of ECR was found between IRMS and INIS (r=0.9829 at 10 min; r=0.9918 at 15 min, P < 0.0001). Analysing the 15-min samples, UBT by both IRMS and INIS achieved the same sensitivity (96. 4%) and specificity (98.9%).

Conclusions: INIS is as effective as IRMS for UBT, and can use a lower dose of (13)C-urea. This can provide an economic UBT, using the lower-priced INIS and a low dose of (13)C-urea.