Citric Acid As The Test Meal for The 13C-Urea Breath Test

Abstract

The data are consistent with the marked effect of citric acid on gastric emptying and, possibly, distribution of the urea within the stomach being largely responsible for the enhanced urease activity with citric acid test meals. It should be possible to use a low dose of citric acid (e.g., 1 g per 200 ml) to enhance the simplicity and palatability of the test.

Comparison between a new 13C-urea breath test, using a film-coated tablet, and the conventional 13C-urea breath test for the detection of Helicobacter pylori infection

“…The use of citric acid enhances the urease activity of H. pylori, and reduces the effect of oral bacteria. [19][20][21] However, citric acid solution is bitter and therefore unpleasant to take. 22 The newly developed UBIT tablet is a film-coated tablet designed to be insoluble in the oral cavity after oral administration, but readily soluble in the stomach.…”

Eradication of Helicobacter pylori Can Be Accurately Confirmed 14 Days after Termination of Triple Therapy Using a High-Dose Citric Acid-Based 13C Urea Breath Test

“…Delta peak values of 13 CO 2 were much higher when 0.1 N citric acid solution was used as the test drink compared to other non-citric acid meals [15]. Comparison of three different concentrations of citric acid, 1, 2 and 4 g, revealed that the increase in urease activity is dose dependent [16]. After reviewing the literature, we found a highly variable time range, 4–28 days, until the false-negative UBT returns to be positive after withdrawal of the PPI [25,26].…”

“…These recommendations were based on earlier studies that showed unacceptable false-negative results at 4 weeks [6, 7]. Use of a high-dose citric acid test meal may alter the gastric milieu, favoring detection of H. pylori even under less than optimal conditions [15,16,17,18]. The results of the present study show the ability of high-dose citric acid-based UBT, to accurately diagnose H. pylori eradication by 14 days after conventional PPI-based triple therapy.…”

“…Indeed, compared to other non-citric acid meals delta peak values of 13 CO 2 were much higher when citric acid solution was used as the test drink [15]. Moreover, citric acid increases the bacterial urease activity in a dose-dependent manner [16]. We and others have recently published that the use of a test drink containing citric acid may decrease significantly the false-negative results associated with PPI treatment [17, 18].…”

Urea Breath Test

“…Citric acid test meals have also been shown to enhance the amount of urea hydrolysis compared with traditional nutrient meals without increasing the rate of false-positive results [ 22 -24 ]. The citric acid test meal also produced a more rapid increase in labeled CO 2 in the breath, suggesting that a post dose breath collection period as short as 10 min might be used for categorization of H. pylori status [ 23 ]. The effect was not due to pH as neither pentagastrin stimulated increase in acidity nor administration of ascorbic acid at a similar pH showed an increase in urea hydrolysis equal to that seen with citric acid [ 23 , 25 ].…”