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Breath Test Detects H. Pylori in Emergency Department Setting

Study supports test-and-treat strategy

Promising results have been reported for the point-of-care BreathID urea breath test (Exalenz Bioscience) as a method for diagnosing Helicobacter pylori infection in the emergency department (ED) setting. The new findings were published online in the Annals of Emergency Medicine.

The prospective cohort study, developed to examine the feasibility of a test-and-treat strategy for H. pylori infection, enrolled 212 patients at an urban academic medical center ED with a high prevalence of H. pylori infection. Symptomatic patients received the BreathID test, and those who tested positive were prescribed standard-of-care triple therapy (i.e., omeprazole, clarithromycin, and amoxicillin). All of the participants were given a baseline questionnaire detailing general demographic information and the nature of pain severity, and those testing positive for H. pylori were also asked additional questions about their medication adherence. The participants were contacted by telephone 2 weeks after the initial assessment with the same questions.

Forty-nine patients (23%) had a positive result; 33 of these 49 patients (67%) self-reported receiving the triple therapy, as prescribed at follow-up; and 23 patients (47%) were retested. The eradication rate of H. pylori was 87% (20/23) among patients who returned for a retest and reported medication compliance. In addition, there was a significant reduction in pain severity, regardless of H. pylori infection status.

A recent article in Expert Review of Molecular Diagnostics noted that standard serological tests for detecting H. pylori may be suboptimal because of the lack of overall accuracy and are consequently not recommended by the U.S., European, and Asia-Pacific consensus guidelines. In addition, antibody titers may decrease up to 6 months after successful treatment, limiting the use of the test for post-eradication confirmation.

“While a test-and-treat approach to H. pylori infection is currently not the standard of care in the emergency room, these data demonstrate that this strategy is viable and may confer additional benefits including early identification and treatment of peptic ulcer disease, and potential to eradicate cases of infection that could lead to an increased risk of developing gastric cancer,” said principal investigator Andrew Meltzer, MD, of the George Washington University Department of Emergency Medicine. “Furthermore, the BreathID test is a noninvasive, accurate, and rapid test for confirming H. pylori infection and is particularly well suited for use at the point-of-care in the emergency department because it offers the significant clinical advantage of detecting only active infection, unlike standard antibody-based testing platforms.”

H. pylori is a Gram-negative, microaerophilic bacterium found in the stomach and linked to the development of various digestive conditions as well as to peptic ulcers and gastric cancer. In the U.S., approximately 20% of people younger than 40 years of age and half of adults older than 60 years of age are infected.

Usually, H. pylori is diagnosed using a blood test. The use of blood testing is limited, however, as it is more invasive then breath testing and doesn’t directly detect the presence of the bacteria. For these and other reasons, leading practice associations, such as American College of Gastroenterology, recommend breath testing as a noninvasive choice for the diagnosis, management, and eradication of H. pylori infection.

Source: PR Newswire; April 13, 2015.

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