Screening of Helicobacter pylori infection in the health examination detected by urea breath test and barium meal study

Background: Helicobacter pylori, H. pylori, is now assumed to be a definite cause of gastric cancer. Health examinations for the early detection of atherosclerotic diseases and malignant diseases have been widely undertaken in Japan, where the incidence of gastric cancer is still one of the highest in the world. To investigate H. pylori infection non-invasively in the regular health examinations, we introduced the urea breath test (UBT) with a barium meal study in the ordinary system. Methods: Sixty male subjects were studied (mean age: 47.8 y/o) in this study. After blood examination for anti H. pylori IgG antibody, the reference expired gas was collected from each subject. Then the subject took 100 mg of C-13-urea dissolved in water with tartaric acid and sodium bicarbonate, which was used to distend the stomach, and an ordinary barium meal study was undertaken. Several rotations of the body were added to subjects for fluoroscopy. Thirty minutes after C-13-urea intake, the expired gas was collected again as the second gas sample. The ratio of C-13 to C-12 in the reference and second expired gas sample was measured with a mass spectrometer and the changed fraction of the isotope concentration, d, was calculated in each subject, The X-ray films of the barium meal study were read independently by one roentgenologist who was not informed at all about this study. Cases were divided into 2 groups: one group without mucosal inflammatory diseases and another group with mucosal inflammatory diseases. Results: The d value for subjects with positive H. pylori antibody and with mucosal inflammatory diseases, who were strongly suggestive of positive H. pylori infection, had a significantly higher value (d: 2.492 +/- 1.372, p < 0.001) than that for subjects with negative H. pylori antibody and without mucosal inflammatory diseases, who were thought not to have H. pylori infection (d: 0.141 +/- 0.107). Subjects who were strongly suggestive of H. pylori infection showed distinctly higher value. Conclusions: Barium did not interfere with the reaction of H. pylori and C-13-urea in the gastric mucosa. UBT can be performed non-invasively together with a barium meal study and it provides useful information on H. pylori infection in the health examination.