• 대한임상검사과학회지
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• 제39권3호
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• pp.271-276
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• 2007

Helicobacter pylori (H. pylori) infection is common in korea and high incidence at gastric ulcer and duodenal ulcer. $^{14}C-urea$ breath test ($^{14}C-UBT$) is regarded as a highly reliable and non-invasive method for the diagnosis of H. pylori infection. The purpose of this study was to evaluate the diagnositc performance of a new and rapid $^{14}C-UBT$, which was equipped with Geiger-Muller counter and compared the results with those obtained by gastroduodenoscopic biopsies (GBx). One hundred sixty-eight patients (M : F = 118 : 50) underwent $^{14}C-UBT$, rapid urease test (CLO test), and GBx. The results of $^{14}C-UBT$ were classified as positive (>50 cpm), borderline (25$^{14}C-UBT$ or CLO test results with GBx as a glod standard. In the assessment of the presence of H. pylori infection, the $^{14}C-UBT$ global performance yielded positive predictive value, negative predictive value and accuracy of 93.3% and 83.3%, respectively. However, the CLO test had performance yielded positive predictive value, negative predictive value and accuracy of 76.9%, 50.0%, respectively. In this study $^{14}C-UBT$ is a highly accurate, simple and non-invasive method or the diagnosis of follow up H. pylori infection.

• 대한핵의학회지
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• 제39권1호
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• pp.21-25
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• 2005

목적: $^{14}C$-요소호기검사(UBT)는 Helicobacter pylori (H. pylori) 감염을 진단하는데 비침습적이고 유용한 방법으로 알려져 있다. 그러나 기존의 $^{14}C$-UBT는 액체 섬광계수기(LS)를 이용하여 측정하므로 검사과정이 복잡하고 시간이 많이 걸리는 단점이 있다. 저자들은 동일한 환자에서 최근에 개발되어 간편해진 $Geiger-M\ddot{u}ller$계수기(GM)를 이용한 측정과 기존의 LS를 이용한 측정을 시행하여 진단성능을 비교하여 GM을 이용한 방법이 기존의 LS를 이용한 방법을 대체할 수 있는지를 알아보고자 하였다. 대상 및 방법: 상부위장관 증상이 있어 일주일 이내에 위십이지장 내시경, LS와 GM을 이용한 $^{14}C$-UBT가 모두 시행된 49명(M:F=30:19, 나이 $41{\pm}14$ yrs)을 대상으로 하였다. 모든 환자에서 최소 6시간 금식을 한 후 37 KBq의 $^{14}C$-urea 캡슐을 복용한 후 LS 와 GM 측정법에 따른 호기 샘플을 얻어 각각 측정하였다. 위십이장 내시경시 시행된 조직 검사 결과를 금과옥조로 H. pylori 감염에 대한 두 계수측정 방법의 진단성능을 비교하였고, 두 측정법의 일치 정도와 측정값 사이의 상관관계를 알아보았다. 결과: 49명중 조직검사를 시행받은 사람은 18명이었으며 이중 H. pylori 감염은 13명(72.2%)에서 관찰되었고 LS와 GM 측정법은 모두 동일한 결과를 보여 민감도 100%, 특이도 100%, 정확도 100%를 보였다. 49명의 대상 환자 전체에서 시행된 두 계수측정법의 일치율은 98%(48/49)이었으며 불일치률은 2% (1/49)였다. LS와 GM에 의한 측정값은 통계학적으로 유의한 상관관계 (r=0.859, p<0.001)를 보였다. 결론: GM을 이용한 $^{14}C$-UBT는 LS 측정법과 동일한 진단성능을 보여, 보다 간편하고 빠른 검사법으로 LS측정법을 대체하여 임상적으로 유용하게 이용될 수 있을 것으로 생각된다.

• 대한핵의학회지
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• 제35권1호
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• pp.61-68
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• 2001

목적: H. pylori는 현재 인체에서 매우 높은 감염률을 보이고 있고 세균의 위내 집락형성이 위염, 궤양성 질환 및 위암 등 많은 위장 질환의 발생과 관련이 있다고 알려져 있다. 본 연구는 비관혈적이고 편리하게 사용될 수 있는 C-14 요소호기검사의 진단성능을 알아보고 정량적 측정치가 내시경 생검에 의한 H. pylori 분포 정도와 상관관계가 있는지를 비교분석함으로써 치료후 추적관찰에 침습적인 내시경적 검사를 대체할 수 있는 유용성이 있는지를 알아보고자 하였다. 대상 및 방법: 최근 4주 이내에 H. pylori 박멸요법을 받지 않는 150명의 환자(남:녀=83:67, 나이, $48{\pm}11.2$세)를 대상으로 균박멸요법 시행전에 위십이지장내시경 및 생검, CLO 검사, C-14 요소호기검사를 시행하였다. 조직생검 결과를 금과옥조로 하여 침습적인 CLO 검사와 비침습적인 C-14 요소호기검사의 H. pylori 감염 진단성능을 비교분석 하였고 Wyatt법에 의한 조직검사의 등급(0-4)과 C-14 요소호기검사의 정량적 수치와의 상관관계를 분석하였다. 결과: H. pylori 감염에 대한 CLO 검사의 민감도 83.2%, 특이도 81.4%, 양성예측도 91.8%, 음성예측도 81.4%, 정확도는 82.7% 이었다. C-14 요소호기검사는 민감도 92.5%, 특이도 88.4%, 양성예측도 97.1%, 음성예측도 88.4%, 정확도는 91.3% 이었다. 병리조직검사에서 등급 0은 $45{\pm}27dpm$, 등급 1은 $707{\pm}584dpm$, 등급 2는 $1558{\pm}584dpm$, 등급 3은 $1851{\pm}604$, 등급 4는 $2719{\pm}892dpm$으로 조직검사의 등급이 높을수록 C-14 요소호기검사의 정량적 수치가 높게 측정되었다(r=0.848, p<0.01). 결론: C-14 요소호기검사는 H. pylori 감염을 진단하는데 CLO 검사에 비하여 높은 민감도와 정확도를 보이는 비침습적이고 간편한 임상적으로 유용한 검사 방법이며, 정량적 수치는 병리조직검사에 의한 H. pylori 분포와 유의한 상관관계를 보여 치료 후 추적관찰에 내시경적 검사와 더불어 균박멸 유무를 진단하는데 유용한 지표로 이용될 수가 있을 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.1797-1802
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• 2013

Background: The aim of this study was to assess clinical factors associated with Helicobacter pylori positivity and to evaluate the incidence of gastric carcinoma in first-degree family members of infected patients. A total of 580 patients (mean age:$38{\pm}17$) with gastrointestinal complaints underwent C-14 urea breath test (UBT). Patients were grouped as: Group-1, untreated patients (n:384); and Group-2, patients who previously treated with eradication triple therapy (n:196). C-14 UBT was performed 1-2 months after the completion of eradication therapy. Associations of H pylori positivity with age, gender, ABO and Rhesus groups, smoking, dietary habits, and history of gastric cancer in first-degree family members were evaluated. The frequency of H pylori positivity was significantly higher in group-1 (58%) compared to group-2 (20%), p=0.001. There were no correlations between H pylori positivity and age, gender, ABO groups, Rhesus subgroups, smoking and dietary habits in both patient groups. The frequency of gastric cancer in family members was significantly higher in patients with H pylori infection among group-1, compared to infected patients among group-2 (56% vs. 28.6% respectively, p=0.03). We observed a significant association between H pylori positivity and the presence of gastric cancer in first-degree relatives of group-1 patients. Our results provide some confirmation of the presence of a link between gastric cancer development and H pylori. C-14 UBT is a sensitive, reliable and a widely recommended test for the detection of H pylori infection and recurrence. We suggest that detection and eradication of H pylori may contribute to a reduced risk of gastric cancer in the family members of infected patients.

• Nuclear Medicine and Molecular Imaging
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• 제42권3호
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• pp.229-234
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• 2008

목적: 최근 들어 H. pylori에 의한 염증이 진행되면 만성 위축성위염을 일으키고 나아가서는 위암을 일으킨다는 학설이 대두되면서 UBT의 이용이 증가되고 있다 저자들은 H. pylori 감염과 분포 정도를 평가하는데 C-14 와 C-13 UBT의 진단성능과 유용성에 차이가 있는지를 알아보았다. 대상 및 방법: 소화불량, 위 팽만감, 상복부동통 등의 상부위장관증상이 있어 위십이지장내시경을 시행 받은 환자 중 균박멸요법을 시행 전에 조직검사, C-14 및 C-13 UBT를 모두 시행 받은 38명(남:녀=28:10, 나이; $53.4{\pm}13.0$세)을 대상으로 하였다. 조직생검 결과를 최적 기준으로 하여 C-14 와 C-13 UBT의 진단성능을 비교하였고 Wyatt법에 의한 조직검사의 등급(0-4)과 C-14 및 C-13 UBT의 정량적 측정치와의 상관관계를 비교하였다. 결과: 조직생검에서 25명(65.8%)에서 H. pylori 감염에 대한 양성을 보였다. H. pylori 감염 진단하는데 C-14 UBT는 민감도 92.0%, 특이도 92.3%, 양성예측도 95.8%, 음성예측도 91.7%, 정확도는 92.1% 이었으나, C-13 UBT는 민감도 96.0%, 특이도 84.6%, 양성 예측도 92.3%, 음성예측도 91.7%, 정확도는 92.1% 이었다. 조직검사 등급에 따른 C-14 UBT 측정치와의 상관성이 C-13 UBT 측정치에 비하여 우수하였다(각각 r=0.948 vs r=0.818, p<0.001). 결론: H. pylori 감염을 진단하는데 C-14 와 C-13 UBT는 유의한 차이는 없으나 C-14 UBT 측정치가 H. pylori 감염 정도를 평가하는데 좀 더 유용할 것으로 생각된다.

• 한국임상약학회지
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• 제22권2호
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• pp.160-166
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• 2012

Purpose: The purpose of the present study was to investigate the pharmacokinetics of urea, a new potential diagnosis reagent of Helicobacter pylori infection. Methods: Considering the mechanism of urea breath test, we determined the excretion of urea in expired air after its oral administration in rats and beagle dogs at the dose of 2 mg/kg (including 50 mCi/mmol $^{14}C$-urea 50 ${\mu}Ci/kg$ for rats and 13.5 ${\mu}Ci/kg$ for dogs). Results: Urea was rapidly disappeared from the blood circulation by 1 hr after its i.v. bolus injection, followed by a slow disappearance by 24 hr. The half-lives at the distributive phase ($t_{1/2{\alpha}}$) and post-distributive phase ($t_{1/2{\beta}}$) were 2 min and 6 hr, respectively. The bioavailability of urea was 64.3% after its oral administration. The values of the volume of distribution ($V_{dss}$) and the total body clearance ($CL_t$) after the oral administration were compatible with those after i.v. administration. The recovery of urea in the bile was about 0.1% of the dose by 24 hr after its oral administration. Urea was extensively eliminated in the urine by 48 hr. The recovery ratios of urea in the urine and expired air were about 86.8% and 2.99% of the dose by 48 hr, respectively. Moreover, urea was mostly distributed from the blood circulation to the kidney, followed by being eliminated in the urine without metabolism. The concentration of urea in the kidney was 4.0 times higher than that of plasma at 40 min after its oral administration. Conclusions: These findings indicated that oral route appears to be available for the administration of urea. Orally administered urea, thus, was considered to be useful for the diagnosis of Helicobacter pylori infection.

• Asian Pacific Journal of Cancer Prevention
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• 제16권10호
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• pp.4353-4356
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• 2015

Background: Levofloxacin is an effective medication for second line Helicobacter pylori (H. pylori) eradication. However, limited studies have approved its use as an effective antibiotic in first line therapy. Dexlansoprazole is a new PPI and lacks of evidence in support of a role in H. pylori eradication. This study was designed to evaluate efficacy of levofloxacin-dexlansoprazole-based quadruple therapy for H. pylori eradication in Thailand. Materials and Methods: This prospective randomized control study was performed during June 2014 to December 2014. H. pylori infected gastritis patients were randomized to receive 7- or 14-day levofloxacin-dexlansoprazole based on quadruple therapy (levofloxacin 500 mg OD, dexlansoprazole 60 mg bid, clarithromycin MR 1000 mg OD, bismuth subsalicylate 1048 mg bid). CYP2C19 genotyping and antibiotic susceptibility tests were conducted for all patients. A 13C urea breath test was performed to confirm H. pylori eradication at least 4 weeks after treatment. Results: A total of 100 patients were enrolled, comprising 44 males and 56 females (mean age of 52.6 years). Eradication rate by PP analysis was 85.7% (42/49) with the 7-day regimen and 98% (48/49) with the 14-day regimen (85.7% vs 98%; p-value=0.059). ITT analysis was 84% and 96% with 7- and 14-day regimens, respectively (84% vs 96%; p-value=0.092). Antibiotic susceptibility testing demonstrated 35.1% resistance to metronidazole, 18.3% to clarithromycin, and 13.5% to levofloxacin. CYP2C19 genotyping revealed 54.1% RM, 34.7% IM and 11.2% PM. The 14-day regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and metronidazole H. pylori resistant strains. Moreover, the eradication rate was 96.6% in patients with CYP2C19 genotype RM. Conclusions: The 14-day levofloxacin-dexlansoprazole based quadruple therapy provides high H. pylori eradication regardless of CYP2C19 genotype, clarithromycin or dual clarithromycin and metronidazole resistant strains. This regimen could be use as an alternative first line therapy for H. pylori eradication in Thailand.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.6089-6092
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• 2015

Background: The prevalence of metronidazole-resistant H. pylori is almost 50% in Thailand which severely limits the use of this drug for eradication therapy. The aims of this study were to evaluate the efficacy and safety profiles of 7-day bismuth-based quadruple therapy including metronidazole as an initial treatment for H. pylori infection in a high metronidazole resistance area. Materials and Methods: This study was performed at Thammasat University Hospital and King Chulalongkorn Memorial Hospital during January 2009 to October 2010. Patients with non-ulcer dyspepsia (NUD) with active H. pylori infection were assigned to receive seven days of quadruple therapy (pantoprazole 40 mg bid, bismuth subsalicylate 1,048 mg bid, amoxicillin 1 gm bid and metronidazole 400 mg tid). H. pylori infection was defined as positive H. pylori culture or two positive tests (rapid urease test and histology). Antibiotic susceptibility test for metronidazole by Epsilometer test (E-test) was performed in all positive cultures. At least four weeks after treatment, $^{13}C$ urea breath test ($^{13}C-UBT$) was performed to confirm H. pylori eradication. Results: A total of 114 patients were enrolled in this study, 50 males and 64 females with a mean age of 49.8 years. All 114 patients had a diagnosis of NUD. Overall eradication as confirmed by negative $^{13}C-UBT$ was achieved in 94 out of 114 patients (82.5%). 44 patients had positive cultures and success for E-test. In vitro metronidazole resistance was observed in 22/44 (50%) patients. Eradication rate in patients with metronidazole resistant strains was 16/22 (72.7%) and 20/22 (90.1%) with metronidazole sensitive strains (72.7% vs 90.1%, p-value=0.12; OR=3.75 [95%CI=0.6-31.5]). Minor adverse reactions included nausea, bitter taste, diarrhea and black stools but none of the patients dropped out from the study. Conclusions: Initial treatment with 7-day bismuth-based quadruple therapy including metronidazole, amoxycillin and pantoprazole is highly effective and well tolerated for metronidazole-sensitive H. pylori infections. However, the efficacy markedly decline with metronidazole resistance. Longer duration of this regimen might be required to improve the eradication rate and larger multi-center studies are needed to confirm this hypothesis.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9909-9913
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• 2014

Background: Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcer disease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However, standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy for H. pylori eradication. Materials and Methods: In this prospective single center study, H. pylori infected gastritis patients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo. Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycin MR once daily and 1,048mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt without probiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication was defined as a negative $^{13}C$-urea breath test at least 2 weeks after completion of treatment. Results: One hundred subjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%, 49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14 regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantly lower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%; p=0.04). Conclusions: The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent cure rate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19 genotype. Adding a probiotic also reduced treatment-related adverse events.

• Asian Pacific Journal of Cancer Prevention
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• 제17권10호
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• pp.4747-4753
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• 2016

Background: The prevalence of Helicobacter pylori (H. pylori) infection in Indonesia has been reported to be exceedingly low. The purpose of our study was to confirm whether this is the case in Northern Jakarta using a sensitive 13C-urea breath test (UBT), and to examine any associations with lifestyle/environment factors and potential routes of transmission. Methods: We recruited a total of 196 subjects from a low-income community in Northern Jakarta, Indonesia, data from 193 who completed a questionnaire about their lifestyle/environment and had UBT being included as the final. Odds ratios (ORs) adjusted for sex and age with 95% confidence intervals (CIs) were calculated using a logistic regression model. Results: The overall H. pylori infection rate was 15.0% (95%CI, 10.3-20.9), with variation among Javanese (9.1%, total=77), Buginese (40.0%, 35), Betawi (9.1%, 33), Sundanese (3.7%, 27), and Batak (40.0%, 5). On multivariate analysis, the ORs for intake of soybean milk, cucumber more than once a week, infrequent hand washing practice before meals, and alcohol consumption were 0.10 (95%CI: 0.01-0.97), 6.61 (95%CI: 1.87-23.3), 4.10 (95%CI: 1.15-14.6), and 61.9 (95%CI: 1.67-2300.8), respectively. Rates for Buginese (OR=7.84; 95%CI: 1.82-33.8) and Batak (OR=20.1; 95%CI: 1.90-213.2) were significantly higher than for Javanese. Conclusions: The H. pylori infection rate in this study was relatively low, in line with previous studies. Regarding ethnicity factors, Buginese and Batak reported eating food using fingers more frequently than Javanese, Betawi, and Sundanese. Our study indicated that person-person transmission is possible in this low prevalence area. The low infection rates for H. pylori among Javanese, Betawi, and Sundanese ethnics could be partly due to their sanitary practices.