Validity and cost comparison of ¹⁴ carbon urea breath test for diagnosis of H Pylori in dyspeptic patients

Aim: To validate and compare the cost of microdose ¹⁴C urea breath test (UBT) with histology and rapid urease test for the diagnosis of H Pylori. Methods: Ninety-four consecutive patients with dyspeptic symptoms undergoing gastroscopy were enrolled. Gastric biopsies were taken for histology and rapid urease test. UBT was performed after gastroscopy by microdose ¹⁴C urea capsules. Sensitivity, specificity and accuracy of UBT were calculated and compared with histology and rapid urease test. Cost comparison of these tests was also performed. Results: H pylori was diagnosed by histology and rapid urease test in 66 (70%) and 61 (65%) patients, while ¹⁴C UBT detected infection in 63 (67%). Accuracy of UBT was 93% in comparison with histology while its positive and negative predictive values were 97% and 84%, respectively. Comparison of ¹⁴C UBT with rapid urease test gives an accuracy of 96%, with positive and negative predictive values of 95% and 97%, respectively. These results were highly reproducible with a Kappa test (P value < 0.001). Cost of histology or rapid urease test with gastroscopy was 110 USD or 95 USD respectively while the cost of UBT was 15 USD. Conclusion: Microdose ¹⁴C UBT was comparable to histology and rapid urease test. ¹⁴C UBT is an economical, self sufficient and suitable test to diagnose active H pylori infection in less developed countries.