Lower‐dose 13C‐urea breath test to detect Helicobacter pylori infection—comparison between infrared spectrometer and mass spectrometry analysis

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Abstract
Background: The expense of the 13C‐urea breath test (UBT) to detect Helicobacter pylori infection is mainly due to the cost of 13C‐urea and the analysis using isotope ratio mass spectrometry (IRMS). Aim: To test whether a UBT, using a lower dose of urea and lower‐priced isotope‐selective nondispersive infrared spectrometry (INIS), can preserve diagnostic efficacy in clinical practice. Methods: A total of 177 dyspeptic patients received endoscopy for H. pylori culture and histology. All of them received a UBT in which the duplicate baseline, 10 min, and 15 min breath samples after ingestion of 50 mg 13C‐urea were collected to analyse the excess 13CO2/12CO2 ratio (ECR) by IRMS (ABCA, Europa Scientific, UK) and INIS (UBiT‐IR200, Photal Otsuka Electronics, Japan), respectively. Results: Of the 177 patients, 84 were infected and 93 were uninfected with H. pylori. A close correlation of ECR was found between IRMS and INIS (r=0.9829 at 10 min; r=0.9918 at 15 min, P < 0.0001). Analysing the 15‐min samples, UBT by both IRMS and INIS achieved the same sensitivity (96.4%) and specificity (98.9%). Conclusions: INIS is as effective as IRMS for UBT, and can use a lower dose of 13C‐urea. This can provide an economic UBT, using the lower‐priced INIS and a low dose of 13C‐urea.