Correlation Of Urea Breath Test Values With Gastric Mucosal Inflammation

Objective:Our aim was to study the correlation ¹³C-urea breath test(¹³C-UBT)value（DOB）between non-neoplasia gastric diseases.This study we designed was to explore the correlation between DOB value of ¹³C-UBT and gastric mucosal inflammation and activity,atrophy,intestinal metaplasia pathological grade,the colonization density of Helicobacter pylori（H.pylori）.We investigated the clinical significance of DOB value in predicting gastric H.pylori density and gastric mucosal inflammation.Methods:We conducted a retrospective cohort study among the ¹³C-UBT test database of Gastroenterology Department of the first and Second Affiliated Hospital of Hainan Medical University.We investigated the correlation between ¹³C-UBT and non neoplastic gastropathy by studying the patients with positive ¹³C-UBT（DOB≥4.0）.The patients were classified into five categories as follows 60 cases of non-atrophic gastritis,60 cases of chronic atrophic gastritis,60 cases of gastric ulcer,60 cases of duodenal ulcer,60 cases of gastric polyp.104 patients which were diagnosed Helicobacter pylori related chronic gastritis（H.pylori gastritis）by testing¹³C-UBT and gastroscopy were enrolled.20 volunteers with negative ¹³C-UBT（DOB<4.0）served as control group.All enrolled patients and volunteers underwented gastroscopy and pathological biopsy of gastric mucosa.According to the DOB value,the patients was divided into four group:DOB<4;4≤DOB<16;16≤DOB≤35;DOB>35.We investigated the relationship between different grades of DOB value of¹³C-UBT with gastric mucosal histological changes in H.pylori gastritis.The receiver operating curve（ROC）was used to evaluate the diagnostic DOB value of ¹³C-UBT in predicting gastric mucosal inflammation and H.pylori density.Results:There was no significant correlation between DOB value of ¹³C-UBT with common non-neoplastic gastric diseases（P>0.05）.Women had significantly higher DOB value than man in non-neoplastic gastric disease（P<0.05）.The degree of activity of gastric mucosa inflammation in patients with H.pylori gastritis were significantly correlated with H.pylori density（P<0.05）,however,the degree of gastric mucosa atrophy and intestinal metaplasia showed that no correlation with H.pylori density（P>0.05）.The ¹³C-UBT DOB value of patients with H.pylori gastritis were positive correlated with H.pylori density.There was no significant correlation between gastric mucosa atrophy and intestinal metaplasia and H.pylori density.H.pylori density,gastric mucosal inflammation and activity were significant increased in DOB value of ¹³C-UBT medium to high value group of H.pylori gastritis（P<0.05）,but,there was no significantly correlation between gastric mucosa atrophy and the histopathological grade of intestinal metaplasia.In ¹³C-UBT using a cut-off from ROC≥7.35 for detection of severe inflammation in gastric mucosa,the diagnostic performance had sensitivity of 91.7%,specificity of 51.9%,and negative predictive value（NPV）of 80.7%.In ¹³C-UBT using a cut-off from ROC≥12.1 for detection of gastric mucosal inflammation with moderate and severe activity,the diagnostic performance had sensitivity of 81.6%,specificity of 50%,and NPV of 86.0%.In¹³C-UBT using a cut-off from ROC≥7.2 for detection of intragastric H.pylori density,the diagnostic performance had sensitivity of 96.7%,specificity of 38.9%,and NPV of 96.5%.In ¹³C-UBT using a cut-off from ROC≥12.1 for detection of massive intragastric H.pylori density,the diagnostic performance had sensitivity of 95.5%,specificity of 48.0%,and the NPV of 98.01%.Conclusions:Delta over baseline（DOB）values of the ¹³C-urea breath test(¹³C-UBT)cann’t be used to estimate the type of non-neoplasia gastric disease.H.pylori density was positively correlated with the inflammation grade and activity in gastric mucosa.The magnitude of DOB of ¹³C-UBT may serve as an indicator for the H.pylori bacterial load in the stomach.The high value of DOB may indicate that very active inflammation in gastric mucosal.DOB value≥7.35 may be used as a preliminary indicator of active inflammation of gastric mucosa in H.pylori gastritis.DOB value≥7.2 indicates H.pylori can be easy detected by gastric mucosa biopsy.The DOB value≥12.1 may be preliminarily predict moderate H.pylori colonization in gastric mucosa,and may be used as a preliminarily indicator of moderately active gastritis.The DOB value of ¹³C-UBT is helpful for the preliminary clinical assessment of H.pylori gastritis,especially as an early warning signal in asymptomatic H.pylori infected patients.However,the DOB value of ¹³C-UBT is not effective diagnosis of gastric mucosa atrophy or intestinal metaplasia,which requires combined gastroscopy and gastric mucosa histological examination.