The Diagnosis of Helicobacter pylori –
what is the current status?
Can the reliability of 1
st
Genera-
tion
13
C Breath Tests be negative-
ly influenced?
Strowski:
Yes, tests that use urea
powder dissolved in fruit juice can
be influenced by the bacterial colo-
nization of the throat or nose.
Orange juice is probably not the
best choice for patients with
problems caused by overproduc-
tion of acid?
Strowski:
Correct, giving fruit juice,
particularly to a fasting patient can
create unnecessary distress. Just
imagine a patient suffering from in-
flammation of the stomach lining, ir-
respective of the cause. And when
performing the test, we also need
to keep in mind any fructose intol-
erant patients. We really don’t want
to have test for fructose intolerance
before every H. pylori diagnosis.
So what does the procedure for
13
C Diabact
®
UBT entail?
Strowski:
Similarly to traditional
tests, the patient is required to have
fasted and to breathe into a small
bag or tube to obtain a base line val-
ue. He then takes the tablet contain-
ing the
13
C Urea with a little water.
10 minutes after taking the pill, the
patient exhales into a small bag or
tube. The
13
C/
12
C ratio in the exhaled
breath is measured by mass spec-
troscopy or infra-red isotope spec-
trometry.
Are the any safety risks to con-
sider with this test?
Strowski:
No, there are no risks.
The
13
C isotope is a stable, non-
radioactive isotope present in our
natural environment.
13
C Urea is ad-
ministered as a tablet with “incorpo-
rated” citrate and is both neutral and
harmless. And because it is in stand-
ardised tablet form, it also ensures a
reproducibly high quality level.
Does Diabact
®
UBT interact with
other medicines or need any oth-
er special consideration?
Strowski:
As in the case of tradi-
tional
13
C Breath tests, the patient
must not have taken any proton
pump inhibitors (PPI) which block
the production of gastric acid for up
to two weeks before the test. This
is because the PPI can lead to re-
duction of the levels of Helicobacter
pylori in the stomach, and therefore
generate false negative results. Tak-
ing antibiotics can also lead to false
negatives and these should also be
discontinued four weeks before the
test.
What about patients suffering
from severely acidic symptoms?
Strowski:
Patients who experience
acute problems through discontinu-
ation of acid blockers can be treated
with antacids for up to 12 hours be-
fore the breath test. There is next to
no interaction with other gastric acid
inhibitors such as H2 blockers, but
these should also be discontinued
24 hours before the test.
A range of non-invasive and in-
vasive tests for the diagnosis of
Helicobacter pylori infections are
available today. In an interview
at the annual United European
Gastroenterology Week in Am-
sterdam 2012, Professor Mathias
Strowski, consultant at the Char-
ité – University of Berlin, Dept. of
Internal Medicine, provided an
overview of the currently avail-
able diagnostic options.
The new, recently published Eu-
ropean guidelines for the man-
agement of Helicobacter pylori
infections, Maastricht IV, rec-
ommend non-invasive testing.
Which non-invasive tests are cur-
rently available?
Strowski:
There are several types
of test available to diagnose such in-
fections. The most straightforward
and non-invasive is the Urea Breath
Test.
How is this test set up and per-
formed?
Strowski:
The patient is required to
fast for six hours prior to the test.
For the conventional test, the pa-
tient ingests 75 to 100mg
13
C urea
dissolved in 200ml orange juice to
delay emptying of the stomach. The
test takes a total of 30 to 45 minutes.
You mention “conventional”
breath tests - have there been
any new developments to
13
C
Urea Breath Tests?
Strowski:
Yes, for some time now
a ready-made tablet, Diabact
®
UBT,
has been on the market. This tablet
is taken with a little water and offers
significant advantages for patient,
clinician and medical staff alike. This
test is much more comfortable for
the patient, takes only 10 minutes
and generates highly reproducible
results.
7
Prof. Dr. med. Mathias Strowski, Berlin
Interview: The Diagnosis of Helicobacter pylori – what is the current status?
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