Randomized Controlled Trial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12888-12895
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12888
Effect of posture on 13C-urea breath test in partial gastrectomy patients
Shu-Ming Yin, Fan Zhang, Dong-Mei Shi, Ping Xiang, Li Xiao, Yi-Qin Huang, Gan-Sheng Zhang, Zhi-Jun Bao
Shu-Ming Yin, Fan Zhang, Dong-Mei Shi, Ping Xiang, Li Xiao, Yi-Qin Huang, Gan-Sheng Zhang, Zhi-Jun Bao, Division of Gastroenterology, Huadong Hospital, Shanghai Medical College of Fudan University, Shanghai 200040, China
Author contributions: Yin SM and Zhang F contributed equally to this work; Yin SM and Zhang F designed the research, analyzed the data and wrote the manuscript; Shi DM, Xiang P, Xiao L, Huang YQ and Zhang GS performed the research; Bao ZJ designed the research and integrated the sections.
Supported by The Guidance Project of Science and Technology Commission of Shanghai Municipality, No. 134119a1700; the Appropriate Project of Shanghai Municipal Health Bureau, No. 2013SY049; Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 13DZ2260700; and the Scientific Research Projects of Shanghai Municipal Health Bureau, No. 20134377.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Huadong Hospital Affiliated to Fudan University.
Clinical trial registration statement: This study is registered at http://www.chictr.org.cn/listbycreater.aspx. The registration identification number is ChiCTR-ICQ-15006798.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Zhi-Jun Bao, Division of Gastroenterology, Huadong Hospital, Shanghai Medical College of Fudan University, No. 221 West Yan’an Road, Shanghai 200040, China. xinyi8681@sina.com
Telephone: +86-21-62487221 Fax: +86-21-62490486
Received: April 19, 2015
Peer-review started: April 21, 2015
First decision: July 10, 2015
Revised: August 3, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: December 7, 2015
Processing time: 231 Days and 0.5 Hours
Abstract

AIM: To investigate whether posture affects the accuracy of 13C-urea breath test (13C-UBT) for Helicobacter pylori (H. pylori) detection in partial gastrectomy patients.

METHODS: We studied 156 consecutive residual stomach patients, including 76 with H. pylori infection (infection group) and 80 without H. pylori infection (control group). H. pylori infection was confirmed if both the rapid urease test and histology were positive during gastroscopy. The two groups were divided into four subgroups according to patients’ posture during the 13C-UBT: subgroup A, sitting position; subgroup B, supine position; subgroup C, right lateral recumbent position; and subgroup D, left lateral recumbent position. Each subject underwent the following modified 13C-UBT: 75 mg of 13C-urea (powder) in 100 mL of citric acid solution was administered, and a mouth wash was performed immediately; breath samples were then collected at baseline and at 5-min intervals up to 30 min while the position was maintained. Seven breath samples were collected for each subject. The cutoff value was 2.0‰.

RESULTS: The mean delta over baseline (DOB) values in the subgroups of the infection group were similar at 5 min (P > 0.05) and significantly higher than those in the corresponding control subgroups at all time points (P < 0.01). In the infection group, the mean DOB values in subgroup A were higher than those in other subgroups within 10 min and peaked at the 10-min point (12.4‰± 2.4‰). The values in subgroups B and C both reached their peaks at 15 min (B, 13.9‰± 1.5‰; C, 12.2‰± 1.7‰) and then decreased gradually until the 30-min point. In subgroup D, the value peaked at 20 min (14.7‰± 1.7‰). Significant differences were found between the values in subgroups D and B at both 25 min (t = 2.093, P = 0.043) and 30 min (t = 2.141, P = 0.039). At 30 min, the value in subgroup D was also significantly different from those in subgroups A and C (D vs C: t = 6.325, P = 0.000; D vs A: t = 5.912, P = 0.000). The mean DOB values of subjects with Billroth I anastomosis were higher than those of subjects with Billroth II anastomosis irrespectively of the detection time and posture (P > 0.05).

CONCLUSION: Utilization of the left lateral recumbent position during the procedure and when collecting the last breath sample may improve the diagnostic accuracy of the 13C-UBT in partial gastrectomy patients.

Keywords: Helicobacter pylori; 13C-urea breath test; Gastrectomy; Position

Core tip: The efficiency of the 13C-urea breath test in the diagnosis of Helicobacter pylori (H. pylori) infection in patients after gastrectomy is still controversial. Many factors may affect the diagnostic accuracy, and posture is especially important. We suggest that residual stomach patients should be kept in the horizontal position on the left side during the procedure and when collecting the last breath sample in order to improve the accuracy of detection of H. pylori infection.