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Noninvasive Diagnosis of Helicobacter pylori Infection in Older Subjects

Comparison of the ¹³C-Urea Breath Test With Serology

^a Department of Geriatrics, S. Bortolo Hospital, Vicenza, Italy.
^b Microbiology Service, S. Bortolo Hospital, Vicenza, Italy.
^c Clinical Pathology Service, S. Bortolo Hospital, Vicenza, Italy.
^d Department of Gastroenterology, Castellana Grotte (BA), Italy.
^e Department of Internal Medicine, University of Bologna, Italy
^f Department of Gastroenterology, University of Padova, Italy.

Alberto Pilotto, Divisione Geriatria, Ospedale Civile S. Bortolo, Via Rodolfi, 37, 36100 Vicenza, Italy E-mail: alberto.pilotto{at}libero.it.

Decision Editor: William B. Ershler, MD

Background. The potential influence of cognitive status, physical activities, comorbidity and cotreatments on the feasibility and diagnostic accuracy of two noninvasive diagnostic tests for Helicobacter pylori (Hp) infection, i.e., the ¹³C-urea breath test (¹³C-UBT) and serology (immunoglobulin G [IgG] anti-Hp antibodies), in older subjects is not known.

Method. The study involved 100 consecutive symptomatic elderly subjects (mean age, 78.3 years; range, 65–96 years), who had undergone an upper gastrointestinal endoscopy. Patients were considered Hp positive if at least two of the three invasive methods, i.e. histology, culture, and/or the rapid urease test were positive for Hp infection. Patients were considered Hp negative if all three invasive methods were negative. The ¹³C-UBT was performed according to the European standard method and the assaying of IgG anti-Hp antibodies by enzyme-linked immunosorbent assay. Cognitive status and functional activities were determined by the Mini-Mental State Examination (MMSE), the activities of daily living (ADLs) and instrumental ADLs (IADLs).

Results. According to invasive methods, 49 patients were Hp positive and 47 were Hp negative (4 subjects were excluded from the study). Hp-positive patients demonstrated a significantly higher prevalence of peptic ulcers (p=.02) and activity of chronic gastritis (p<.0001) than Hp-negative subjects. The ¹³C-UBT demonstrated a sensitivity of 100%, a specificity of 95.7%, and a diagnostic accuracy of 97.9%. Serology had significantly lower sensitivity (74.4%), specificity (59%), and diagnostic accuracy (67%, p<.001) than the ¹³C-UBT. The feasibility and the diagnostic accuracy of the ¹³C-UBT were not altered by the cognitive status (MMSE) and functional activities (ADL, IADL) of the patients, their drug consumption, or the prevalence of concomitant diseases.

Conclusions. In older subjects, the ¹³C-UBT had a significantly higher diagnostic accuracy than serology without influence of cognitive function, disability, comorbidity and cotreatments. This method may be considered an excellent, clinically useful, noninvasive test for the diagnosis of Hp infection in older subjects.