Clinical experience of use of 13C-breath tests in oesophagogastroduodenal diseases: selective questions

Abstract

Introduction: Motility disorders can be an important factor in the occurrence of symptoms of dyspepsia that consequently require evaluation of clinical significance of noninvasive diagnostic approaches when observing patients with functional dyspepsia (FD), gastroesophageal reflux disease (GERD), and Helicobacter pylori-associated diseases of the stomach and duodenum. Aim: To determine the relationship between various motility disorders and to improve the diagnostics and treatment with the use of 13 C-urea (UBT) and 13 C-octanoic breath tests (OBT). Material and methods: A total of 591 patients, aged 18-83 years, who underwent upper gastrointestinal endoscopy at our department were evaluated. Age, sex, and duration of symptoms of dyspepsia were recorded. UBT and OBT were examined in patients with dyspepsia, GERD, and H. pylori-associated diseases. Results: Patients with dyspepsia syndrome had H. pylori infection in 70 ±1.3% of cases. The strategy of "test-and-treat" using UBT can be applied in 76.5% of cases of unexplained dyspepsia in the Ukrainian population. In patients with GERD, slowing down of the gastric emptying (GE) prevails (overall 79.7 ±4.4%), which is a reliable predictor of early relapse of GERD symptoms (OR = 4.9, 2.4-7.0). In the case of H. pylori-associated diseases, the slowing down of GE according to OBT data is a prognostic sign of the return of the symptoms of dyspepsia after successful eradication of H. pylori (OR = 2.1, 1.9-2.3). In H. pylori-associated diseases with a slow GE, recurrence of dyspeptic syndrome after H. pylori-eradication therapy is observed in 33.1% of cases; the appointment of prokinetics reduces this probability to 9.2% (p = 0.0074). Conclusions: Investigations into the clinical use of new facilities of 13 C-breath tests in gastroenterology are shown. The clinical efficacy of urea and octanoic breath tests in FD, GERD, and H. pylori-associated diseases was proven experimentally among patients of the Ukrainian population. New simplified diagnostic and treatment approaches were proposed for certain groups of patients with gastric dyspepsia syndrome, based on the results of the UBT and the OBT.