Background: Conventional 13C‐urea breath testing (13C‐UBT) includes a test meal to delay gastric emptying, which, theoretically, improves the accuracy of the test. Citric acid has been proposed as the best test meal. However, recent studies have suggested that a test meal may not be necessary. Aim: To investigate a new 13C‐UBT protocol without a test meal in a Chinese population. Methods: Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13C‐UBT was performed on two separate days with or without a test meal (2.4 Gm citric acid) and compared with the ‘gold standard’ (CLO test and histology). Results: Two hundred and two patients were tested. Using receiver operating characteristics (ROC) analysis, the optimal delta‐value and optimal measurement interval for UBT were 5% and 30 min, respectively, both with or without a test meal. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 13C‐UBT with citric acid (96.5%, 97.7%, 98.2%, 95.6%, 97.0%) were similar to 13C‐UBT without a test meal (94.7%, 97.7%, 98.2%, 93.5%, 96.0%). Conclusion: This simplified 13C‐UBT protocol without a test meal produced highly accurate and reliable results in the Chinese population.
Background: The proportion of duodenal ulcers not associated with Helicobacter pylori infection or the use of non‐steroidal anti‐inflammatory drugs (NSAIDs) is increasing. Aim: To identify the clinical and endoscopic characteristics of non‐H. pylori, non‐NSAID duodenal ulcers. Methods: Clinical and endoscopic data and H. pylori status were prospectively collected from consecutive patients who underwent upper endoscopy from 1997 to 1999. Patients with duodenal ulcers were identified, and those with non‐H. pylori, non‐NSAID duodenal ulcers were analysed further. Results: A total of 11 717 upper endoscopies were performed in 8344 patients. Of these, 1153 (14%) had duodenal ulcers. Of 599 patients with active ulcers and known H. pylori status, 104 (17%) had ulcers not associated with H. pylori or the use of NSAIDs, 393 (66%) had ulcers associated with H. pylori alone, 51 (8.5%) had ulcers associated with the use of NSAIDs alone and 51 (8.5%) had ulcers associated with both. Multivariate logistic regression analysis revealed that the presence of concomitant diseases (odds ratio=15.0; 95% confidence interval, 8.64–25.9; P < 0.001) and the absence of epigastric pain/discomfort (odds ratio=0.52; 95% confidence interval, 0.29–0.91; P=0.022) were independent predictors for non‐H. pylori, non‐NSAID duodenal ulcers. Conclusions: Non‐H. pylori, non‐NSAID duodenal ulcers exhibit certain distinct clinical and endoscopic characteristics. The presence of concomitant diseases is an important predictive factor.
INTRODUCTIONHelicobacter pylori establishes long-term chronic infections in the human gastric mucosa that can lead to active chronic gastritis and peptic ulcer disease, and is an early risk factor for gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. 1±4 Metronidazole is frequently included as one component in multi-drug treatment regimens. However, the prevalence of metronidazole resistance in some populations is very high, and this decreases the overall success rate of metronidazole-based eradication regimens. 5±7 Two related chromosomal nitroreductase genes, rdxA (HP0954) and frxA (HP0642) in the genome sequence, have been implicated in susceptibility and resistance to metronidazole of H. pylori strains from diverse parts of the world, including East Asia. 8±11 The nitroreductase enzymes these genes encode can activate metronidazole by converting it from a harmless pro-drug to a mutagenic and bactericidal agent (probably hydroxylamine). Most metronidazole-resistant clinical isolates contain loss of function mutations in rdxA, and inactivation of rdxA in metronidazole-susceptible strains is generally suf®cient to make them resistant to moderate levels of metronidazole (16 lg/mL, up from SUMMARY Background: Diversity in metronidazole susceptibility and genotypes of Helicobacter pylori have been reported with varying results in different areas. Aims: To investigate the prevalence of multiple strain infection in a symptomatic Chinese population and to determine the metronidazole susceptibility pattern and genotypic characteristics of these infecting strains. Methods: Gastric biopsies from antrum, body and cardia were taken during upper endoscopy in symptomatic patients referred to our department. Pooled cultures and single colony isolates were obtained and tested for metronidazole susceptibility and random ampli®ed polymorphic DNA (RAPD) ®ngerprint patterns.
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