Microdose 14C-Urea Breath Test Offers Diagnosis of Helicobacter pylori in 10 Minutes

Objectives: The urea breath test diagnoses Helicobacter pylori infection of the stomach by identifying the urease enzyme activity of the bacterium. In this "micro-dose" version of the test, 1 μCi ¹⁴C-urea is given orally in a capsule. Our objectives were: 1) to evaluate a microdose ¹⁴C-urea breath test capsule in a gastroenterology outpatient setting, 2) to determine the diagnostic ranges of the ¹⁴C-urea breath test for HP-positive and HP-negative patients, 3) to define the sensitivity and specificity of the test, and 4) to see whether breath sample results changed when they were mailed to a remote site for analysis. Methods: In a prospective blinded study, we breath-tested 200 fasted patients before elective outpatient endoscopy. At endoscopy, two gastric biopsy samples were taken and were examined for curved organisms; a third biopsy specimen was evaluated with a rapid urease test (CLOtest). Breath samples were mailed in aluminized balloons to a testing laboratory. Results: Using a single breath sample collected at 10 min, with ≥ 200 dpm as positive, the breath test correctly classified 63 of 65 HP-positive patients (sensitivity 97%, CI 89–99%), and 128 of 135 HP-negative patients (specificity 95%, CI 90–98%). Radiation exposure from the test equated to natural background received in 1 day. No adverse events were caused by the breath test. Conclusions: The ¹⁴C-urea capsule breath test (PYtest) is a convenient noninvasive test for the detection of gastric H. pylori infection. Accuracy is equivalent to invasive methods such as histology. Results can be obtained within 15 min if a counting instrument is nearby, or breath samples can be mailed to a testing laboratory for analysis.     

Prolonged Effect of Omeprazole on the 14C-Urea Breath Test

Objectives : We investigated omeprazole's effect on ¹⁴C-urea breath testing. We also determined the duration of omeprazole's effect on the breath test. Finally, we studied whether effects on breath testing were dose dependent. Methods : Fifty-seven employees and outpatients were screened for Helicobacter infection. Those positive for serology, CLO, or histology were asked to undergo baseline breath testing. Those with a positive breath test took omeprazole 20 mg/day for 14 days followed by repeat breath testing 1, 3, and 5 days after therapy. Subjects with persistently positive breath tests despite omeprazole 20 mg/day were asked to take omeprazole 20 mg b.i.d. for 14 days. Repeat breath tests were performed as above. Results : Thirteen of 57 had HP infection. Ten of 13 underwent a baseline breath test. Eight of 10 with baseline breath tests experienced a significant decrease in expired ¹⁴CO₂ after omeprazole 20 mg/day. Five of 13 with active HP infection developed a negative breath test after omeprazole. All subjects had a positive breath test within 5 days of stopping omeprazole 20 mg/day. Five of eight with persistently positive breath tests despite omeprazole 20 mg/day took omeprazole 40 mg/day. Four of five developed a significant decrease in ¹⁴CO₂ excretion after omeprazole. All subjects had a positive breath test within 5 days of stopping omeprazole 40 mg/day. Conclusions : Recent treatment with omeprazole 20 mg/day led to false-negative breath tests in 38.5%. This effect appeared to be dose dependent and lasted up to 5 days after cessation of omeprazole.     

Performance of acidified 14C-urea capsule breath test during pantoprazole and ranitidine treatment

Background and Aim:  Urea breath test (UBT) results could be false negative in patients taking antisecretory drugs. This effect would be prevented by citric acid administration during UBT. We prospectively investigated whether acidified ¹⁴C-urea capsule prevents false negative UBT results in patients taking antisecretory drugs and show interference with the duration of medications.
Methods:  Sixty Helicobacter pylori positive patients were included. Pantoprazole (40 mg/day) was given to 27 patients for 28 days and ranitidine (300 mg. o.d.) to 33 patients for 60 days. Urea breath tests were repeated on days 14 and 28 in both groups and on day 60 in the ranitidine group.
Results:  The baseline mean breath counts of two groups did not show any significant difference. Pantoprazole led to a significant decrease in mean breath counts on day 14 ( P  < 0.005). Six of 27 and 3 of 25 patients taking pantoprazole developed negative or equivocal UBT results on days 14 and 28, respectively. Two of 32, 2 of 32 and 3 of 21 patients taking ranitidine developed negative or equivocal UBT results on days 14, 28 and 60, respectively.
Conclusions:  The use of acidified ¹⁴C-urea capsule did not prevent false negative UBT results in patients taking pantoprazole and ranitidine, and the duration of medication does not affect the test results.     

Effect of Administration of Ranitidine Bismuth Citrate with Food on the Suppression and Eradication of Helicobacter pylori in Infected Volunteers

Objective : This study examined the effect of administration with food on the ability of ranitidine bismuth citrate to suppress and eradicate Helicobacter pylori in 41 infected volunteers. Results : After a 7-day course of treatment with ranitidine bismuth citrate (400 mg b.i.d. ), 90% (18/20) of subjects who received the drug with food compared with 55% (11/20) of subjects who received the drug without food tested H. pylori -negative in a ¹³C-urea breath test ( p = 0.031). Follow-up ¹³C-urea breath tests performed at least 3 months after therapy showed that H. pylori was eradicated in 14% (2/14) of subjects who received ranitidine bismuth citrate with food compared with 0% (0/18) of subjects who received ranitidine bismuth citrate without food ( p = 0.183). The incidence of potentially drug-related adverse events was similar regardless of whether subjects received ranitidine bismuth citrate with or without food. Headache was the most common potentially drug-related adverse event. Conclusions : These data demonstrate that administration of ranitidine bismuth citrate with food compared with without food significantly improves the suppression of H. pylori in infected volunteers.     

Comparison of Helisal Rapid Blood Test and 14C-Urea Breath Test in Determining Helicobacter pylori Status and Predicting Ulcer Disease in Dyspeptic Patients

Objective: Noninvasive tests for Helicobacter pylori are used increasingly. Our aim was to compare the Helisal Rapid Blood (HRB) test and ¹⁴C-urea breath test (UBT) for determining H. pylori status and predicting ulcer disease.
Methods: Three hundred fifty-one consecutive patients with dyspepsia (mean age 40 yr; range 16–77 yr) had an HRB test and UBT followed by endoscopy with biopsies of the antrum and body for histology and antral urease slide test (CLO test). Patients were excluded if they had previously confirmed ulcer disease, gastric surgery, or anti- H. pylori therapy or were taking nonsteroidal anti-inflammatory drugs.
Results: Sixty-three percent of the patients were "gold standard" H. pylori positive (positive CLO test, positive staining), 34% were gold standard negative (negative CLO test, negative staining), and 3% had conflicting CLO test and histology. The UBT was superior to HRB for determining H. pylori status (sensitivity 98% vs 92%,   p = 0.04  ; specificity 100% vs 69%,   p < 0.001  ). The specificity of the HRB decreased with increasing patient age (74% for age < 46 yr; 57% for age ≥46 yr). A negative UBT was superior to a negative HRB test for predicting the absence of ulcer disease (47% vs 36%;   p < 0.01  ). A positive UBT was similar to a positive HRB in predicting the presence of ulcer disease (92% vs 84%;   p = 0.23  ).
Conclusions: The HRB test is inferior to the UBT for determining H. pylori status. The tests have a similar ability to predict the presence of ulcer disease when positive, but a negative UBT is a better predictor of the absence of ulcer disease.     

Seasonal Variation in the Frequency of Helicobacter pylori Infection: A Possible Cause of the Seasonal Occurrence of Peptic Ulcer Disease

Objective: The seasonal variation of duodenal ulcer disease and its complications have been repeatedly demonstrated in Israel by several independent studies. The aim of this study was to determine possible seasonal variations in the occurrence of H. pylori infection among dyspeptic patients in Israel. Methods: All ¹⁴C-urea breath tests performed in dyspeptic patients at the gastroenterology department in the Tel Aviv Medical Center from January 1991 to December 1992 were reviewed. The monthly variation in the proportion of patients with H. pylori infection was determined, and compared with that of an unrelated ¹⁴C-cholyl-glycine breath test. Results: Altogether, 702 patients were examined, and 371 (52.8%) of them were found to be infected with H. pylori . During summer months (July-September), a significant decrease in the percentage of patients infected with H. pylori was found, compared with winter months (December-January, 42.3% vs . 60.9%, p < 0.007). No seasonal variation was found in the results of ¹⁴C-cholyl-glycine test. The fluctuations in H. pylori infection were highly correlated with the seasonal occurrence of peptic ulcer disease in Israel. Conclusions: The frequency of H. pylori infection in dyspeptic patients in Israel is significantly increased during the winter months and decreased in the summer. This seasonal variation is identical to that found in duodenal ulcer disease. Thus, the seasonal variation of peptic ulcer disease could be explained by H. pylori infection, as seen in other communicable infectious diseases.     

Effect of Standard and High Dose Ranitidine on [13C]Urea Breath Test Results

Objective: It has been suggested that standard dose H2 blockers will affect the [¹⁴⁻C]urea breath test. The aim of this study was to evaluate the effect of standard and high dose ranitidine on the [¹³C]urea breath test in a prospective cross-over study.
Methods: Volunteers found to be positive for H. pylori by IgG serology and [¹³C]urea breath test were given either ranitidine 150 mg b.i.d. or 300 mg b.i.d. for 14 days. Repeat breath tests were completed on the last day of antisecretory dosing and study patients were immediately crossed over to the other ranitidine dose. The third breath test was performed at 14 days after initiation of the new dose.
Results: A total of 20 volunteers were enrolled. Using the established cut-off of 2.4% for the commercial breath test, only one patient developed negative results on H2 blockers. This patient had negative breath tests on both ranitidine doses and remained test-negative off all medications 6 wk after study completion, suggesting either a false positive baseline test or an unexpected bacterial eradication. No specific trend in breath test results was observed for the group (   p = NS  ). On ranitidine 300 mg, six of 19 patients elevated their breath results from 23% to 112% (mean 76%) above baseline.
Conclusion: Ranitidine at standard or high doses did not generate a reproducible decline in breath test results. Histamine 2 blockers do not need to be discontinued before urea breath testing.     

Medium-Term Results of Oral and Intravenous Omeprazole/Amoxicillin Helicobacter pylori Eradication Therapy

Objectives : The aim of the present study was to examine the effect of the application route of the antibiotic amoxicillin in Helicobacter pylori eradication, using omeprazole/amoxicillin. Methods : In a prospective medium-term study, 31 patients with H. pylori -positive gastroduodenal ulcer disease were treated with a 14-day course of 20 mg omeprazole bid orally, combined with either 1 g amoxicillin tid intravenously (n = 15) or 500 mg amoxicillin six times daily orally (n = 16). Results : H. pylori eradication, defined as negative bacterial findings in urease test, culture, and histology at least 4 wk after cessation of study medication, was achieved in 93% (14/15) of the patients in the first group and in 91% (11/12) of the patients in the second group. To obtain medium-term results, patients in whom H. pylori had been successfully eradicated were investigated with a ¹³C-urea breath test at least 6 months later. Medium-term eradication rates of 91% (10/11 patients) in the first and 100% (10/10 patients) in the second group were observed. Conclusions : In view of the equally high eradication rates obtained by a 14-day course of intravenously administered amoxicillin and an oral therapy of the same length and dosage, during the necessary induction of luminal hypoacidity by the proton pump inhibitor omeprazole, we conclude that the route of administration of amoxicillin does not play a decisive role in bacterial eradication.     

Cure of Helicobacter pylori Infection: Role of Duration of Treatment with Omeprazole and Amoxicillin

Objectives : To date, some studies have suggested that short-term therapy may be a promising therapeutic concept for the eradication of Helicobacter pylori . The primary objective of the present study was to elucidate the role of the duration of treatment in the cure of H. pylori infection. Methods : Forty consecutive patients with H. pylori -positive peptic ulcer disease were randomly allocated to four study groups. The groups were treated with a 14-day course of 20 mg omeprazole b.i.d. orally combined with 2 g amoxicillin t.i.d. intravenously for 1 day (n = 10; six women, age range 40–84 yr), for 3 days (n = 10; three women, age range 29–74 yr), for 5 days (n = 10; five women, age range 21–82 yr), and for 7 days (n = 10; five women, age range 42-82 yr), respectively. Initially, a standardized clinical evaluation of symptoms and an upper GI tract endoscopy were performed for assessment of H. pylori infection of the gastric mucosa (biopsy urease test, specific culture, and histology). At least 4 wk after cessation of omeprazole medication, H. pylori eradication was evaluated either as described or with the help of the ³¹C-urea breath test. Results: H. pylori eradication, defined as negative bacterial findings in urease test, culture, and histology or ³¹C-urea breath test at least 4 wk after discontinuation of omeprazole therapy, was achieved in one of 10 patients (10%) in the one-day group, none of 10 patients (0%) in the 3- and 5-day groups and six of 10 patients (60%) in the 7-day group. Conclusions : We conclude that short-term therapies with the proton pump inhibitor omeprazole and the antibiotic amoxicillin must be considered completely ineffective if performed as a short-term therapy for up to 5 days. A therapy duration of 7 days seems to mark a turning point in antibiotic effectiveness, with a rapid increase in eradication rates.     

Safety and efficacy of rabeprazole in combination with four antibiotic regimens for the eradication of Helicobacter pylori in patients with chronic gastritis with or without peptic ulceration

Objectives: Rabeprazole is a new fast acting proton pump inhibitor that has recently been proven to be effective in the treatment of peptic ulceration and reflux esophagitis. The aim of this study was to evaluate rabeprazole in combination with antibiotics for the eradication of Helicobacter pylori ( H. pylori ) in patients with chronic active gastritis with or without peptic ulcer disease.
Methods: Seventy-five H. pylori -infected patients were randomized in a double-blind fashion to receive a 7-day treatment regimen consisting of: RAC, RAM, RCM, or RC (R = rabeprazole 20 mg b.d. , A = amoxycillin 1 g b.d. , C = clarithromycin 500 mg b.d. , M = metronidazole 400 mg b.d. ). Randomized patients were H. pylori -positive by gastric biopsy urease test, histology and ¹³C urea breath test (¹³C-UBT). H. pylori eradication was assessed by ¹³C-UBT, 4 and 8 wk after finishing treatment. Endoscopy with histology and culture for antibiotic sensitivity testing was performed pretreatment and if treatment failed.
Results: On an intention-to-treat analysis, treatment success was: RCM 100%, RAC 95%, RAM 90%, and RC 63%. The most common side effects were loose stools, headache, and taste disturbance, but there were no serious adverse events related to the study medication. The two patients failing RAM treatment had metronidazole-resistant strains before and after treatment. None of the pretreatment H. pylori isolates from six patients failing RC were clarithromycin resistant, but three of five successfully cultured posttreatment had developed clarithromycin resistance.
Conclusion: Rabeprazole-based triple therapy with two antibiotics for 1 wk is safe and effective in eradicating H. pylori . Dual therapy with clarithromycin is less successful, and the majority of treatment failures develop clarithromycin resistance.     

Identification and eradication of Helicobacter pylori infection in haemophilic patients

The aim of this study was to identify and eradicate H. pylori infection in patients with haemophilia. Patients were screened for IgG antibodies against H. pylori ; active infection was determined using a ¹³C-urea breath test and infected patients were given combination therapy with antibiotics to eradicate infection. Seventy-eight of 219 (36%) patients with haemophilia were found to have an elevated serum antibody titre against H. pylori ; of 36 antibody-positive patients with confirmatory testing, 14 were found to have active H. pylori infection. H. pylori infection was successfully eradicated in every infectedpatient using acombination of ranitidine plus two antibiotics (usually amoxycillin and metronidazole). It is concluded that eradication of H. pylori infection is likely to be a cost-effective screening strategy in patients with haemophilia, to prevent complications of peptic ulcer disease.     

Reproducibility and Simplification of 13C-Octanoic Acid Breath Test for Gastric Emptying of Solids

Objective: The accuracy of the ¹³C-octanoic acid breath test is enhanced by breath sampling over 6 h rather than 4 h, but this increases the cost of the test. Our aim was to validate a less costly but accurate sequence of breath sampling for measuring gastric emptying of solids.
Methods: We performed the ¹³C-octanoic acid breath test and tested its reproducibility relative to simultaneous scintigraphy in 30 healthy volunteers.
Results: There was a significant but weak correlation between t _1/2 measured by the two tests (   r _s= 0.54  ,   p < 0.005  ), but not between the duration of the lag phase. The differences in the t _1/2 measurements between the tests were different between subjects but were highly reproducible within subjects. Within- and between-subject variations of measurements of gastric emptying with the ¹³C-octanoic acid breath test were not significantly different from the variations observed with scintigraphy. A subset of 11 breath samples collected over 6 h (24 samples) predicted (   r ² > 0.95  ) the variables characterizing the cumulative appearance of ¹³CO₂ in breath; these samples were at 35, 50, 95, 110, 140, 155, 215, 245, 260, 290, and 335 min. The accuracy of this subset of sampling times was confirmed in a separate set of breath test samples over 6 h from the same 30 subjects.
Conclusions: The ¹³C-octanoic acid breath test for gastric emptying of solids is as reproducible as scintigraphy. A subset of 11 sampling times provides sufficient information to characterize the whole breath-test curve, but the sampling period should be extended to 6 h after dosing.     

Prevalence of Helicobacter pylori Infection in Endoscopy and Non-Endoscopy Personnel: Results of Field Survey with Serology and 14C-Urea Breath Test

Objectives: The aims of the study were, first, to determine the prevalence of Helicobacter pylori (HP) am ONG endoscopy personnel and a group of non-endoscopy volunteers and, second, to evaluate the usefulness of two noninvasive tests of diagnosis: serology and the urea breath test. Methods: The two noninvasive methods of HP diagnosis, serology and ¹⁴C-urea breath test (UBT), were used in a cross-sectional survey of endoscopists, nurse-assistants, and non-endoscopy personnel. Results: One hundred and thirty-five volunteers were recruited for the study. In 116, results of the two tests were in agreement (K = 0.645). Further analysis was based on the results of the UBT. Endoscopy personnel (endoscopists and nurse-assistants) as a group had a significantly higher incidence of HP than did controls (32.9% vs. 11.3%; p = 0.004). The two groups were comparable with regard to mean age, sex, ethnic distribution, and social class. Conclusions: HP infection is more prevalent among endoscopy personnel. Both diagnostic tests (serology and UBT) were convenient and relatively simple to perform, and results gave a high level of agreement.     

Helicobacter pylori Reinfection Rate, in Patients with Cured Duodenal Ulcer

Objective: To determine the reinfection rate of the gastric mucosa in patients previously cured of duodenal ulcers, following the eradication oi Helicobacter pylori . Only those remaining H. pylori-negative beyond 12 months of follow-up were studied, to minimize the potential inclusion of patients with H. pylori recrudescence. Methods: Patients with endoscopically proven duodenal ulcers who had heen treated with triple therapy, resulting in documented eradication of H. pylori and cure of the ulcer for at least 4 years, were recalled and had their H. pylori status determined by the ¹⁴C-urea breath test. Those found positive for H. pylori underwent endoscopic confirmation of the infection. Results: Of the 94 patients restudied, with a follow-up period range of 48–96 months or a total of 549.8 yr, only two (2.2%) were again H. pylori positive. This gives an effective reinfection rate of 0.36% per patient year. In the two H. Pylori -positive patients, one had normal mucosa endoscopically, whereas duodenitis without active ulceration was present in the other. The former was asymptomatic, whereas the latter patient was using ranitidine daily for symptom control. Conclusion: In the Australian setting, following cure of duodenal ulcer disease by eradication of H. pylori , subsequent reinfection is an unusual phenomenon. We conclude that efforts aimed at eradication of H. pylori in duodenal ulcer are justified and are worthwhile.     

The Epidemiology of Helicobacter pylori in Peruvian Children between 6 and 30 Months of Age

Objectives: Cross-sectional studies of children in developing countries show a high prevalence of Helicobacter pylori infection at 6 months of age, hut a decrease in the prevalence of infection hetween 1 and 5 yr of age. The decrease suggests a loss or clearance of infection, an uncommon finding in adults. Our ohjective in this study was to determine the longitudinal persistence of H. pylori infection in young childen. Methods: We tested an initial cohort of 105 6-month-old infants at 6-month intervals with the ¹³C-urea hreath test; 56 subjects were successfully studied for 2 yr or until 30 months of age. Results: Overall prevalence decreased from 71.4% to 47.9% when children were hetween 6 and 18 months of age, and we found a significant gender difference (males 63.6–55.0%, females 80.0–38.7%, p = 0.03). Of the 56 subjects, six had negative hreath tests at all 6-month intervals, 10 were consistently positive, and 36 suhjects had one or more negative tests after a positive test. The overall prohahility of acquiring H. pylori in a given 6-month period ranged between 0.28 and 0.38; tbe probability of clearing the infection was between 0.22 and 0.45. During the first 18 months after birth, male infants were more likely to acquire H. pylori and less likely to clear the infection than female infants. Conclusion: We conclude that H. pylori colonization in infants may be a reversible process.     

Randomized Comparison of Ranitidine Bismuth Citrate-Based Triple Therapies for Helicobacter pylori

Objectives: In an attempt to increase the efficacy and simplicity of FDA-approved regimens for Helicobacter pylori , we studied (1) addition of an inexpensive antibiotic (amoxicillin) to twice-daily ranitidine bismuth citrate (RBO-clarithromycin dual therapy, and (2) substitution of RBC for bismuth subsalicylate + H2-receptor antagonist in bismuth-based triple therapy. Methods : Subjects with previously untreated Helicobacter pylori infection documented by ¹³C-urea breath test plus either endoscopic biopsy or serology were randomly assigned to a 2-wk course of (1) RBC 400 mg b.i.d. , amoxicillin 1 g b.i.d. , and clarithromycin 500 mg b.i.d. (RAC), or (2) RBC 400 mg b.i.d. , metronidazole 250 mg t.i.d. , and tetracycline 500 mg t.i.d. (RMT). Repeat breath test was performed 4 wk after the completion of therapy. Results : Intent-to-treat and per-protocol cure rates for RAC were 46 of 50 patients (92%) and 45 of 47 patients (96%); for RMT they were 40 of 50 patients (80%) and 37 of 42 patients (88%). Study drugs were stopped due to side effects in three patients (6%) taking RAC and six patients (12%) taking RMT. Conclusions : Twice-daily RBC-based triple therapy with clarithromycin and amoxicillin produces Helicobacter pylori eradication rates over 90%, which is comparable to rates seen with proton pump inhibitor-based triple therapies. RBC also may be substituted for bismuth subsalicylate and an + H2-receptor antagonist in standard bismuth-based triple therapy.     

Five-Day Bismuth-Free Triple Therapy for the Eradication of Helicobacter pylori and Reduction of Duodenal Ulcer Relapse

Previous studies have demonstrated that the eradication of Helicobacter pylori ( H. pytori ) is associated with a significant reduction of the rate of duodenal ulcer (DU) relapse. The aim of this study was to assess the long-term effect of a bismuth-free triple therapy on the eradication of H. pylori and reduction of DU relapse. After informed consent, 61 patients with endoscopically proven DU and H. pylori infection detected on ¹⁴C-urea breath test (BT) were included in the study. All patients received a combination of furazolidone, amoxicillin, and metronidazole, three times a day, for 5 days, in addition to eventual classical antiulcer agents prescribed by their attending physicians. BT was repeated after an interval of at least 60 days to evaluate H. pylori eradication. Endoscopy and another BT were performed again at 6.5 months after therapy to detect possible recurrences. Forty-eight patients completed the trial: 26 (54%) patients were negative for H. pylori at 6.5 months after the end of treatment, and 22 (46%) persisted H. pylori positive. Ninety-two percent of the patients in whom the bacteria were eradicated showed endoscopically healed ulcers and were asymptomatic, and two that were sympatomatic presented only occasional pain not requiring therapy. Among the 22 patients who persisted H. pylori positive, six (27%) showed endoscopically active ulcers ( p = 0.012) and eight (36%) patients continued to be symptomatic ( p < 0.01), and were still using antiulcer drugs ( p < 0.002) 6.5 months after treatment. It is concluded that combined treatment with furazolidone, amoxicillin, and metronidazole for 5 days represents a well-tolerated, inexpensive, and effective therapeutic regime for the eradication of H. pylori and abolition of DU relapse in more than 50% of the patients during a follow-up period of 6.5 months.     

Xylose-1-14 C Absorption Test: The use of Urine, Serum and Breath Analysis, and Comparison with a Colorimetric Assay

Summary: Xylose-1-¹*C absorption test: The use of urine, serum and breath analysis, and comparison with a colorimetric assay. R. K. Roberts, C. B. Campbell, S. J. Bryant and L. Adames, Aust. N.2. J. Med, 1976, 6, pp. 532–536.
The xylose absorption and excretion test has been reassessed in controls and patientswith coeliac disease. Xylose has been assayed in both serum and urine colorimetrically and by liquid scintillation counting using xylose-1-¹⁴ C The excretion of ¹⁴CO₂ in breath following administration of xylose-1- ¹⁴ C has been measured.
Liquid scintillation counting is a simple and reliable method for the measurement of xylose absorption. Serum xylose levels, urinary xylose excretion, or breath ¹⁴ CO_z in isolation were poor screening tests for mucosal disease. The use of serum levels and urinary excretion in combination improved the discriminatory value of the test though small gut biopsy was more reliable.     

Cure of Helicobacter pylori infection and healing of duodenal ulcer: comparison of pantoprazole-based one-week modified triple therapy versus two-week dual therapy

Objective: Eradication of Helicobacter pylori ( H. pylori ) is recommended as the first-line therapeutic concept for reliable long-term prevention of duodenal ulcer (DU) relapse. Current treatment regimens vary in efficacy, complexity, and compliance. To assess the efficacy of pantoprazole in H. pylori eradication in parallel groups of patients using two eradication regimens.
Methods: Patients, (18–85 yr old; intention-to-treat,  n = 286  ) with proven DU, positive rapid urease test (biopsy), and ¹³C-urea breath test (UBT) were included in a prospective, randomized, multicenter study. Modified triple therapy consisted of 40 mg pantoprazole b.i.d ., 500 mg clarithromycin t.i.d ., and 500 mg metronidazole t.i.d . for 7 days (PCM therapy); dual therapy consisted of 40 mg pantoprazole b.i.d . and 500 mg clarithromycin t.i.d . for 14 days (PC therapy). In both groups 40 mg pantoprazole o.d . was given until day 28 when healing of DU was evaluated endoscopically; H. pylori status was assessed by UBT on day 56.
Results: H. pylori eradication rate was 95% in PCM versus 60% in PC therapy groups (per-protocol population,   p < 0.001  ), and 82% in PCM versus 50% in PC therapy in the intention-to-treat patient population (   p < 0.001  ). The DU healing rate was 98% in the PCM and 95% in the PC therapy groups (per-protocol population). Both regimens were similarly well tolerated. Adverse events in both regimens included taste disturbance, diarrhea, and increased serum concentration of liver enzymes, at an incidence of < 10%.
Conclusions: Compared to 2-wk PC therapy (pantoprazole and clarithromycin), the 1-wk PCM therapy (pantoprazole, clarithromycin, and metronidazole) is a significantly superior and highly promising strategy for eradication of H. pylori .     

One-Week Triple Therapy With Ranitidine Bismuth Citrate, Clarithromycin and Metronidazole Versus Two-Week Dual Therapy With Ranitidine Bismuth Citrate and Clarithromycin for Helicobacter pylori Infection: A Randomized, Clinical Trial

Objective: The aim of this study was to compare the efficacy and side effects of 1-wk triple therapy with ranitidine bismuth citrate (RBC) 400 mg b.i.d. , clarithromycin 500 mg b.i.d. , and metronidazole 500 mg b.i.d. , to 2-wk dual therapy with RBC 400 mg b.i.d. and clarithromycin 500 mg b.i.d. for H. pylori infection in a randomized, clinical trial.
Methods: Patients (18–80 yr) with a culture proven H. pylori infection were randomized to one of these regimens. Side effects were scored on a semiquantitative scale. Endoscopy was performed ≥4 wk after treatment. Antral biopsy samples were taken for hematoxylin-eosin stain (HE), rapid urease test, and culture and corpus samples for culture and HE. Two weeks after the endoscopy, a ¹³C-urea breath test was performed. Eradication failure was defined as detection of H. pylori by culture or by at least two other tests.
Results: A total of 104 patients, 54 men, age 54 ± 14 yr, (36 duodenal ulcer, 16 gastric ulcer, and 52 functional dyspepsia) were included. Gender, age, and diagnosis were comparable in both groups. Fourteen of 52 patients in both triple and dual therapy, respectively, had significant side effects, but all patients completed the course. Eradication results were 49 of 52 (94%; 95% CI: 84–99%) and 50 of 52 (96%; 95% CI: 87–100%) on intention to treat analysis and 44 of 46 (96%; 95% CI: 85–99%) and 48 of 49 (98%; 95% CI: 89–100%) on per protocol analysis for triple and dual therapy respectively.
Conclusion: Both regimens are very effective and well tolerated in the treatment of H. pylori infection. The triple regimen has the advantage of being shorter.