Brief Reports
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2005; 11(4): 584-586
Published online Jan 28, 2005. doi: 10.3748/wjg.v11.i4.584
Breath and string test: A diagnostic package for the identification of treatment failure and antibiotic resistance of Helicobacter pylori without the necessity of upper gastrointestinal endoscopy
Andreas Leodolter, Kathlen Wolle, Ulrike von Arnim, Stefan Kahl, Gerhard Treiber, Matthias P. Ebert, Ulrich Peitz, Peter Malfertheiner
Andreas Leodolter, Kathlen Wolle, Ulrike von Arnim, Stefan Kahl, Gerhard Treiber, Matthias P. Ebert, Ulrich Peitz, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Andreas Leodolter, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, D - 39120 Magdeburg, Germany. andreas@leodolter.de
Telephone: +49-391-6713100 Fax: +49-391-6713105
Received: April 4, 2004
Revised: April 6, 2004
Accepted: June 26, 2004
Published online: January 28, 2005
Abstract

AIM: Helicobacter pylori (H pylori) resistance after failed eradication has a major impact on the outcome of a further treatment regimen. The aim of this study was to assess the validity of a non-invasive strategy using the 13C-urea breath test (UBT) and the gastric string test in identifying post-treatment resistance of H pylori.

METHODS: The UBT was routinely performed 4 to 6 wk after H pylori eradication therapy. Forty-two patients (24 females, 18 males, mean age 48 years) with a positive UBT were included in the study. A gastric string test using a capsule containing a 90 cm-long nylon fiber was performed. Before the capsule was swallowed, the free end of the string was taped to the cheek. After one hour in the stomach, the string was withdrawn. The distal 20 cm of the string was inoculated onto an agar plate and processed under micro-aerophilic conditions. Following the string test, upper gastrointestinal endoscopy was performed to obtain gastric biopsies for conventional culture.

RESULTS: H pylori was successfully cultured from the gastric string in 34 patients (81%), but not in 5 patients due to contamination with oropharyngeal flora. H pylori was cultured from the gastric biopsies obtained at endoscopy in 39 patients (93%).

CONCLUSION: The UBT followed by the gastric string test in the case of treatment failure is a valid diagnostic strategy with the aim of determining the post-therapeutic antibiotic resistance of H pylori with little inconvenience to the patient. Upper GI-endoscopy can be avoided in several cases by applying consequently this diagnostic package.

Keywords: Helicobacter pylori; Antibiotic resistance; 13C-urea breath test; Gastric string test