This study tested the influence of pretreatment bacterial density on the eradication rate of Helicobacter pylori with triple therapy. One hundred and thirty two patients with endoscopically confirmed H pylori positive, duodenal ulcer or antral gastritis were treated with triple therapy (colloidal bismuth/metronidazole/amoxicillin) for two weeks. Pretreatment urease activity was assessed by the "4C-urea breath test (UBT) in all patients. The mean (SD) pretreatment UBT concentration was similar in patients with duodenal ulcers (318.4 (175.0)) and patients with antral gastritis (288.9 (165.5)). Rauws et al have shown that one of the advantages of the urea breath test in the diagnosis of H pylori infection is that it also gives a quantitative assessment of the bacterial density in the stomach and correlates well with the histological findings.'1 This correlation has been validated recently by several independent studies. 12-14The purpose of this study was to evaluate the eradication rate of triple therapy in our patient population, and to examine the effect of the pretreatment bacterial density assessed by the 14C-urea breath test (UBT), on the eradication rate with this regimen.
MethodsThe study included patients referred to our gastroenterology service for upper gastrointestinal symptoms, who were found to have endoscopically verified duodenal ulcers or chronic antral gastritis. During endoscopy prepyloric antral biopsy specimens were taken for histological examination and for rapid urease testing. In all patients 14C-UBT was performed before starting treatment for H pylori eradication. Patients were treated with the regimen: colloidal bismuth subcitrate (CBS, De-Nol) 120 mg four times daily, amoxicillin 500 mg thrice daily, and metronidazole 250 mg twice daily for 14 days. All the patients underwent a 14C-UBT four weeks after completion of the treatment for evaluation of H pylori eradication.
SUMMARY The hydrogen breath test was performed by ingestion of 20 g lactulose and analysis of end-expiratory air. Eighteen patients undergoing colonoscopy, 17 receiving antibiotics, 12 prepared for colon surgery, and 15 controls were examined. The test was repeated under control conditions in the treated patients. Eleven of 55 subjects failed to produce significant amounts of hydrogen under control conditions. This 20% proportion of non-hydrogen producers is much higher than that reported by other investigators. The hydrogen production was very markedly depressed after preparation for colonoscopy and antibiotic therapy. The effect of neomycin and enemata as used in preparation for colon surgery was less marked. Hydrogen production by the colonic flora is thus subject to individual variations and may be affected by various therapeutic regimens. All these may cause false negative results when using the hydrogen breath test to evaluate carbohydrate absorption. The test should therefore not be performed for a considerable time after therapeutic manipulation of the colonic flora.The introduction of the hydrogen breath test (Bond and Levitt, 1972) 23 November 1977 predictable amounts of hydrogen in the process. The purpose of the present study was to evaluate the effect of alterations in the colonic flora on the hydrogen breath test.
Methods
SUBJECTSSixty-two subjects were studied from the outpatient and inpatient population of our hospital. Twenty-seven were females and 35 males, aged 13-79 years, with a mean of 52-6 ± 15-3 years.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.