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Gastroenterology
PYtest Helicobacter Breath Test



PYtest Helicobacter Breath Test
PYtest

Termed the PYtest, this simple non-invasive procedure can determine if an individual actually harbors the H. pylori organism. Here are a few questions that you may have.

What is Helicobacter pylori? Also termed H. pylori, Helicobacter is a bacteria that is amazingly able to thrive in the harsh acid environment of the upper digestive system. It has recently been found to be the major cause of peptic ulcer disease and gastritis - accounting for over 75% of all ulcers. The other major cause of ulcers is the use of antiinflammatory drugs like aspirin and arthritis medications.

Why should it be treated?

In the past, most ulcer patients suffered from one or two flare ups each year - typically in the spring and fall. No good explanation was known. Now we know that may have been due to this chronic bacterial infection. We also now know that destroying the H. pylori can markedly reduce the return rate of peptic ulcer disease and prevent future complications.

In addition, studies have confirmed that chronic infection with H. pylori is a risk factor in the development of stomach cancer. In fact, the World Health Organization has classified H. pylori as a Class I carcinogen. Treatment and eradication of the infection can reduce this risk.

How is H. pylori treated?

H. pylori is commonly treated with a combination of acid-reduction therapy like Prilosec or Prevacid combined with several antibiotics for one to two weeks. A variety of regimens are available. Which treatment is best depends on the patient, their individual allergies, and their doctor's preference.

However, the antibiotics are not without unpleasant side effects and some patients do not complete the full course of therapy. Often they do not share this information with their doctor. Even with a full course of therapy, the cure rate is only about 75- 85%. If the full course of treatment is not taken, the cure rate falls even more. Thus, despite treatment, not every case of H. pylori is eradicated with therapy.

How do I know if the treatment worked?

First of all, symptoms are not a good guide. The H. pylori organism can persist long after an ulcer is healed and may not cause symptoms for many months or years. All the while it may be causing damage or heading for stomach cancer.

Also, the serum or fingerstick blood tests are not helpful to determine cure since they measure the antibody to H. pylori, not the actual infection. This antibody may linger in the blood for years after the infection is eradicated.

One way to determine if the infection was abolished is to perform a repeat stomach scope test and take a biopsy of the stomach lining. While scope tests still play a major role in diagnosis, a repeat exam solely to test for H. pylori is seldom justified. In the past, there just was no good way to be sure the infection was gone - until, the PYtest came along.

What is the PYtest?

The PYtest is a safe non-invasive breath test that can determine if the bacteria is still thriving in your stomach. The test is quite simple. After fasting six hours, the patient takes a capsule that contains the tracer C14. Ten minutes later, the patient is asked to take a deep breath and blow up a small mylar balloon. The breath sample can then be analyzed in our newly acquired Tri-Med liquid scintillation counter.

What preparation is needed? Before the PYtest the patient must be off all antibiotics and PeptoBismol for one month. You must not have taken Prilosec, Prevacid, or Carafate for the past two weeks. Antacids such as Maalox and medications such as Tagagmet, Zantac, Pepcid, and Axid are permissible. On the day of the test , the patient must be fasting for 6 hours. A small amount of water to take any necessary medications is permissible. Any such medications should be taken at least two hours before the PYtest.

How is the test reported?

If H. pylori infection is present, carbon dioxide in the breath sample will contain traces of C14. This will be detected by our liquid scintillation counter which measures radiation in dpm (disintegrations per minute) A reading over 200 dpm is considered positive. A reading below 50 is normal.

As an example, Dr. Fusco recently took the PYtest in a demonstration. He was surprised to learn that his reading was quite elevated at 1501 dpm! He was infected with H. pylori without even knowing it - no symptoms and no signs. By contrast, one of our administrators who served as a control had a reading of 11 and was not considered infected.

Is the PYtest safe?

Yes. That is an important question since the PYtest utilizes a capsule which does contains a small amount of C14 tracer. During the test, the patient is exposed to about the same amount of radiation as 1/20th of a chest x-ray. Fifteen glasses of orange juice contain the same amount of C14. This amount of radiation is so small that it is felt to be harmless by the Nuclear Regulatory Commission and there are no special precautions. Any residual C14 leaves your body through the urine and is gone in a few hours.

Who should have a PYtest?

The PYtest does not replace the need for evaluation of patients who present with symptoms. Those patients should still be investigated as appropriate to their presenting complaint. This may involve special diagnostic studies such as scope tests, x-rays, blood tests, etc.

The main indication for the PYtest is the patient who has recently undergone treatment for H. pylori or has been treated in the past. All of these individuals should have a PYtest. It should be done about one month or longer after completion of therapy to determine if the infection was successfully cured.

The test is also helpful for those individuals who have equivocal blood test results for H. pylori. The antibiotic regimen for H. pylori is not without risks and somewhat unpleasant to take. So if the H. pylori blood test is only minimally elevated, the PYtest can determine if an infection is actually present. If you have any questions about your possible need for a PYtest, consult with your physician.


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved





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