13C urea breath test to identify Helicobacter pylori Infection in patients with upper gastrointestinal bleeding admitted to the Emergency Department

OBJECTIVE: Upper gastrointestinal bleeding (UGIB) is a cause of Emergency Department (ED) visits. Peptic ulcer secondary to H.\r\npylori (HP) infection and/or to the use of NSAIDs\r\nis the most frequent cause. The aim of the study\r\nis to evaluate directly in the ED the prevalence of\r\nHP infection through Urea Breath test (UBT) in\r\npatients admitted to the ED for UGIB.\r\nPATIENTS AND METHODS: We enrolled 87 patients (58M/29F) with a mean age of 63.8 + 11.7\r\nyrs with an active UGIB who performed EGDS\r\nand UBT.\r\nRESULTS: 34.4% of patients performing EGDS\r\nand UBT resulted positive to HP. Peptic ulcer was\r\npresent in 20/30 (66.7%) of HP+ compared to 20/57\r\n(35.1%) of HP- (p<0.001), and also gastritis and/or\r\nduodenitis were mostly present in HP+ (23.3% vs.\r\n15.8%) (p<0.05). A biopsy was performed in only\r\n31% of patients with a positive rate of 33.3%. In 78%\r\nwe obtained a correspondence between UBT and\r\nbiopsy results. Compared to biopsy result, we obtained for UBT a positive predictive value (PPV) of\r\n71% and a negative predictive value (NPV) of 80%.\r\nTaking the UBT as a gold standard, we obtained for\r\nbiopsies a PPV of 69% and a NPV of 85%.\r\nCONCLUSIONS: Our study confirms that the\r\nuse of UBT directly in ED in patients with UGIB allows for a rapid, reliable and non-invasive diagnosis of HP infection as a causative agent for bleeding, thus permitting a right etiological treatment.