Helicobacter pylori in vivo diagnosis after food intake: results of simultaneous [15N]urea urine and [13C]acetate breath tests

The protocols for 13C and 15N H. pylori tests stipulate that the diagnostic agent should be taken on an empty stomach. It is presumed that food intake prior to the tests leads to less reliable test results due to a prolongation of the gastric residence time of the diagnostic agent urea. This might allow the bacteria to split a higher proportion of urea, resulting in an increased number of false positives. 12 probands received 150mg [15N]urea and 75 mg sodium [13C]acetate in 75 ml orange juice as a test drink. [15N]Urea served as an agent to diagnose gastric H. pylori colonization. The 15N tests were evaluated using a urine sample of the second hour after test start. [13C]Acetate served as a marker of the gastric emptying of water-soluble food including the urea under the influence of food intake. Breath air samples were taken to calculate the gastric emptying half life (EHL) and the apparent resorption time (RT) of the urea. The double tests were carried out four times within four weeks using identical test protocols but different standardized time periods of pretest fasting: overnight, two hours prior to test, one hour prior to test, and no fasting at all. The food intake amount was standardized. Five probands testing positive in the overnight fasting test were also found to be positive in the other test variants with more or less empty stomachs. Seven other probands testing negative after overnight fasting tested negative in the other test variants as well. It is concluded that food intake prior to the test drink does not have much of an influence on the gastric residence time of urea and so on the qualitative H. pylori test results. Due to identical behaviour of [13C]urea and [15N]urea in the stomach, this influence is believed to be independent on the labelling isotope. For survey purpose, no fasting conditions are required for the H. pylori tests.