Posttreatment 13C-urea breath test is predictive of antimicrobial resistance to H. pylori after failed therapy

Abstract

OBJECTIVE:We tested whether a 13 C-urea breath test can predict antimicrobial resistance of Helicobacter pylori (H. pylori). METHODS:Seventy patients who had failed triple eradication therapy and 108 untreated H. pylori-infected patients were given a 13 C-urea breath test, endoscopy for culture of H. pylori, and assessment of clarithromycin resistance. The patients who had failed triple therapy then received 1 week of quadruple therapy to eradicate residual H. pylori. RESULTS:The posttreatment value of the 13 C-urea breath test expressed as excessive d 13CO 2 per ml (ECR) was higher in patients with residual H. pylori with clarithromycin resistance than in those without (23.8 vs 10.6; Po.0001). With a cutoff of ECR 4or 15, the 13 C-urea breath test was 88.6% sensitive and 88.9% specific in predicting clarithromycin resistance of residual H. pylori. The H. pylori eradication rate of the rescue regimen was higher for patients with a posttreatment ECR of the 13 C-urea breath test 15 than for those with a value 415 (93.8% vs 73.3%; Po.05). In contrast, in treatment-naive H. pylori-infected patients, the pretreatment value of the 13 C-urea breath test did not differ between patients infected with clarithromycin-resistant or-sensitive isolates (P4.05). CONCLUSION:The posttreatment value of the 13 C-urea breath test is predictive of clarithromycin resistance in residual H. pylori after failed triple therapy and predicts efficacy of the rescue regimen. The value of the noninvasive test is promising for primary care physicians who need to select a rescue regimen without invasive H. pylori culture.

13C-Urea Breath Test Values and Helicobacter pylori Eradication

“…Whether such a difference, although not statistically significant, is clinically relevant could be disputed. It has been recently observed that patients harboring H. pylori strains with secondary clarithromycin resistance showed DOB values distinctly higher than those infected with susceptible strains (23.8 vs. 10.6), whilst a similar difference did not appear for primary clarithromycin resistance (28.9 vs. 23.8) [20]. In agreement with the latter finding, our data showed no correlation between primary claritromycin resistance and DOB values.…”

“…According to DOB values, the eradication rates and their 95% confidence intervals were calculated, subgrouping patients into low (DOB: <16), intermediate (DOB: [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], and high (DOB >35) bacterial load, as suggested in previous studies [9,10]. In order to evaluate the possible role of DOB values and other variables on H. pylori eradication success, a stepwise discriminant regression analysis was performed.…”

“…Beside these peculiarities, DOB values of UBT have been significantly related with different bacterial characteristics and clinical settings. In detail, DOB values have been correlated with gastric bacterial load [4][5][6][7], bacterial strain virulence (CagA positive > CagA negative) [19], clarithromycin resistance [20], fluoro-2-deoxy-d-glucose uptake in the stomach at positron emission tomography [21], patient gender (females > males) [22], intensity of dyspeptic symptoms [23] and, inconsistently, with the gastric pathology (peptic ulcer > non-ulcer dyspepsia) [8,19,24]. Moreover, several studies have found that UBT ( 13 C or 14 C) results significantly affect therapy outcome, with the probability of cure being inversely correlated with DOB values [8][9][10][11][12][13][14].…”

Diagnosis of Helicobacter pylori Infection

“…A DOB value, > 35, predicted a lower eradication rate (81.6%) than a DOB value < 35 (94.7%) [40], as previously published. Furthermore, in another study, following eradication attempts, high post‐treatment DOB values (> 15) were predictive of clarithromycin resistance [41]. It was interesting to see that tuberculosis treatment cleared H. pylori in all patients, but eradication only occurred in 37% as tested by a 14 C‐UBT [42].…”

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis

“…Therefore, successful eradication of H. pylori is a crucial component in the treatment of gastroenterologic and hematologic diseases including chronic gastritis, peptic ulcers, gastric adenocarcinoma, gastric-mucosa-associated lymphoid tissue lymphoma, sideropenic anemia, and primary immune thrombocytopenia. Nevertheless, H. pylori eradication rate of first-line triple regimen and rescue regimen with various patterns of antibiotic resistance are from 55 to 90 % and 70 to 90 % throughout the world (30)(31)(32). Furthermore, because of the use of antibiotics in eradication therapy, they kill not only H. pylori, but also the normal flora in the stomach, equivalent to further damage of the gastric micro-ecological environment which leads to the bacterial superinfection and H. pylori infection recurrence.…”