Digestive Diseases and Sciences

, Volume 49, Issue 11–12, pp 1840–1844 | Cite as

13C-Urea Breath Test for Diagnosis of Helicobacter pylori Infection in the Elderly

  • Yaron NivEmail author
  • Galia Niv
  • Rivka Koren


Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the 13C-urea breath test (13C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13C-UBT was performed with 75 mg urea labeled with 13C. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70–102 years, 958 (45%) men, referred for 13C-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive 13C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13C-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.

Helicobacter pylori geriatrics eradication therapy 13C-urea breath test 


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  1. 1.
    Peterson WL, Graham DY: Helicobacter pylori. In Sleienger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed. Philadelphia, W. B. Saunders, 2002, pp 732–746Google Scholar
  2. 2.
    Williams MP, Pounder RE: Helicobacter pylori: From the benign to the malignant. Am J Gastroenterol 94 (Suppl):s11–s16, 1999CrossRefPubMedGoogle Scholar
  3. 3.
    Asaka M, Sugiyama T, Nobuta A, et al.: Atrophic gastritis and intestinal metaplasia in Japan: Results of a large multicenter study. Helicobacter 6:294–299, 2001CrossRefPubMedGoogle Scholar
  4. 4.
    Nakamura M, Haruma K, Kamada T, et al.: Cigarette smoking promotes atrophic gastritis in Helicobacter pylori-positive subjects. Dig Dis Sci 47:675–681, 2002CrossRefPubMedGoogle Scholar
  5. 5.
    Tsukui T, Kashiwagi R, Sakane M, et al.: Aging increases and duodenal ulcer reduces the risk for intestinal metaplasia of the gastric corpus in Japanese patients with dyspepsia. J Gastroenterol Hepatol 16:15–21, 2001CrossRefPubMedGoogle Scholar
  6. 6.
    Haruma K, Kamada T, Kawaguchi H, et al.: Effect of age and Helicobacter pylori infection on gastric acid secretion. J Gastroenterol Hepatol 15:277–283, 2000CrossRefPubMedGoogle Scholar
  7. 7.
    Pilotto A, Salles N: Helicobacter pylori infection in geriatrics. Helicobacter 7 (Suppl 1):56–62, 2002CrossRefPubMedGoogle Scholar
  8. 8.
    Brock J, Sauaia A, Ahnen D, et al.: Process of care and outcomes for elderly patients hospitalized with peptic ulcer disease. Results from a quality improvement project. JAMA 286:1985–1993, 2001CrossRefPubMedGoogle Scholar
  9. 9.
    Huang JQ, Subbaramiah S, Hunt RM: Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic ulcer disease: A meta-analysis. Lancet 359:214–225, 2002Google Scholar
  10. 10.
    Chan FKI, To KF, Wu JCY, et al.: Eradication of Helicobacter pylori and rosk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: A randomized trial. Lancet 359:9–13, 2002CrossRefPubMedGoogle Scholar
  11. 11.
    Sheu BS, Lee SC, Yang HB, Lin XZ: Quantitative results of 13C urea breath test at 15 minutes may correlate with the bacterial density of H. pylori in the stomach. Hepatogastroenterology 46:2057–2062, 1999PubMedGoogle Scholar
  12. 12.
    Hawtin PR: Serology and urea breath test in the diagnosis of H. pylori infection. Mol Biotechnol 11:85–92, 1999CrossRefPubMedGoogle Scholar
  13. 13.
    Perri F, Clemente R, Pastore M, Quitadamo M, Festa V, Bisceglia M, Li Bergoli M, Lauriola G, Leandro G, Ghoos Y, Rutgeerts P, Andriulli A: The 13C urea breath test as a predictor of intragastric bacterial load and severity of Helicobacter pylori gastritis. Scand J Clin Lab Invest 58:19–27, 1998CrossRefPubMedGoogle Scholar
  14. 14.
    Cutler AF, Prasad VM: Long term follow-up of Helicobacter pylori serology after successful eradication. Am J Gastroenterol 91:85–88, 1996PubMedGoogle Scholar
  15. 15.
    Perez-Perez GI, Culter AF, Blaser MJ: Value of serology as a noninvasive method for evaluation the efficacy of treatment of Helicobacter pylori infection. Clin Infect Dis 25:1038–1043, 1997CrossRefPubMedGoogle Scholar
  16. 16.
    Pilotto A, Franceschi M, Leandro G, et al.: Nonivasive diagnosis of Helicobacter pylori infection in older subjects: Comparison of the 13C-urea breath test with serology. J Gerontol A Biol Sci Med Sci 55:M163–M167, 2000CrossRefPubMedGoogle Scholar
  17. 17.
    Novis BH, Gabay G, Naftali T: Helicobacter pylori: The Middle East scenario. Yale J Biol Med 71:135–141, 1998PubMedPubMedCentralGoogle Scholar
  18. 18.
    Malfertheiner P, Megraud F, O’Morain C, Hungins APS, Jones R, Axon A, Graham DY, Tytgat G, the European Helicobacter pylori study group (EH.PYLORISG). Current concepts in the management of Helicobacter pylori infection—The Maastricht 2-2000 consensus report. Aliment Pharmacol Ther 16:167–180, 2002CrossRefPubMedGoogle Scholar
  19. 19.
    Lind T, Veldhuyzen van Zanten SJO, Unge P: Eradication of Helicobacter pylori using one week triple therapies combining omeprazole with two antimicrobials—The MACH 1 study. Helicobacter 1:138–144, 1996CrossRefPubMedGoogle Scholar
  20. 20.
    Lind T, Megraud F, Unge P, et al.: The MACH2 study: role of omeprazole in eradication of Helicobacter pylori with 1 week triple therapies. Gastroenterology 16:248–253, 1999CrossRefGoogle Scholar
  21. 21.
    European Helicobacter Pylori Study Group: Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut 41:8–13, 1997CrossRefGoogle Scholar
  22. 22.
    Pilotto A, Franceschi M, Leandro G, et al.: Efficacy of 7 day lansoprazole-based triple therapy for Helicobacter pylori infection in elderly patients. J Gastroenterol Hepatol 14:464–471, 1999Google Scholar
  23. 23.
    Catalano F, Branciforte G, Brogna A, et al.: Helicobacter pylori-positive functional dyspepsia in elderly patients. Comparison of two treatments. Dig Dis Sci 44:863–867, 1999CrossRefPubMedGoogle Scholar
  24. 24.
    Pilotto A, Malfertheiner P: Review article: An approach to Helicobacter pylori infection in the elderly. Aliment Pharmacol Ther 16:683–691, 2002CrossRefPubMedGoogle Scholar
  25. 25.
    Pilotto A, Franceschi M, Leandro G, et al.: Cure of Helicobacter pylori infection in elderly patients: Comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole. Aliment Pharmacol Ther 15:1031–1036, 2001CrossRefPubMedGoogle Scholar
  26. 26.
    Ammon S, Treiber G, Kes F, Klotz U: Influence of age on the steady state disposition of drugs commonly used for the eradication of Helicobacter pylori. Aliment Pharmacol Ther 14:759–766, 2000CrossRefPubMedGoogle Scholar
  27. 27.
    Perri F, Villani MR, Festa V, et al.: Predictors of failure of Helicobacter pylori eradication with the standard “Maastricht triple therapy,” Aliment Pharmacol Ther 15:1023–1029, 2001CrossRefPubMedGoogle Scholar
  28. 28.
    Meyer JM, Silliman NP, Wang W, et al.: Risk factors for Helicobacter pylori resistance in the United States; The surveillance of H. pylori antimicrobial resistance partnership (SHARP) study, 1993–99. Ann Intern Med 136:13–24, 2002CrossRefPubMedGoogle Scholar
  29. 29.
    Younger J, Duggan A: Helicobacter pylori infection in the elderly. Lancet 360:947, 2002 (letter)CrossRefPubMedGoogle Scholar
  30. 30.
    Banks L, Wright JP, Marks IN: Peptic ulcer: A follow-up study. J Clin Gastroenterol 8:381–384, 1986CrossRefGoogle Scholar
  31. 31.
    Salles N, Dertheil S, Broutet N, Gras N, Monteiro L, Mascarel MD A, Megraud F, Emeriau J: Detecting Helicobacter pylori infection in hospitalized frail older patients: The challenge. J Am Geriatr Soc 50:1674–1680, 2002CrossRefGoogle Scholar
  32. 32.
    Moayyedi P, Chalmers DM, Axon AT: Patient factors that predict failure of omeprazole, clarithromycin, and tinidazole to eradicate Helicobacter pylori. J Gastroenterol 32:24–27, 1997CrossRefPubMedGoogle Scholar
  33. 33.
    Graham DY, Lew GM, Malaty HM, Evans DG, Evans DJ Jr, Klein PD, Alpert LC, Genta RM: Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology 102:493–496, 1992CrossRefPubMedGoogle Scholar
  34. 34.
    Chiba N, Rao BV, Rademaker JW, Hunt RH: Meta-analysis of the efficacy of antibiotic therapy in eradication of Helicobacter pylori. Am J Gastroenterol 87:1716–1727, 1992PubMedGoogle Scholar
  35. 35.
    Avidan B, Weiss B, Chowers Y, Younash A, Bar-Meir S, Keler N: Sensitivity and resistance of Helicobacter pylori to antibiotic treatment. Harefuah 137:272–274, 1999PubMedGoogle Scholar
  36. 36.
    Samra Z, Shmueli H, Niv Y, Dinari G, Ofek I, Passaro DJ, Geler A, Gal E, Fishman M, Bachor J, Yahav J: Resistance of Helicobacter pylori isolates in Israel to metronidazole, clarithromycin, tetracycline, amoxicillin and cefoxime. J Antimicrob Chemother 49:1023–1026, 2002CrossRefPubMedGoogle Scholar
  37. 37.
    Weisfeld AS, Simmons DE, Vance PH: In vitro susceptibility of pre-treatment isolates of Helicobacter pylori from the multicenter United States clinical trials. Gastroenterology 110:A295, 1996 (abstract)Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  1. 1. Helicobacter Pylori Central Laboratory, Clalit Health Services (CHS), Department of Gastroenterology, Rabin Medical CenterTel Aviv UniversityBeilinson CampusIsrael

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