Laser Based ¹³C-urea Breath Test in Quantitative Assessment of Bacterial Colonization, Severity of Inflammation and Atrophy in Gastric Mucosa

Aim: to compare the results of ¹³C-UBT with the data of morphological analysis of the gastric and duodenal mucosa obtained during gastroduodenoscopy in gastritis and peptic ulcer. To analyze the dependence of the results of diode laser spectroscopy (DLS) based ¹³C-UBT on age, nosology, activity and severity of the inflammatory process, the degree of atrophy and metaplasia.

Materials and methods. The ¹³C-UBT DLS was performed in 525 patients before the start of eradication therapy and in 196 patients 10–12 weeks after its completion. The breath test was carried out according to a standard protocol using the BSIA patent kit (Great Britain). During endoscopy, 134 patients underwent a biopsy from the upper third of the body of the stomach, the antrum (within 5 cm from the pylorus along the greater curvature) and the duodenal bulb with histological examination with hematoxylin-eosin staining, PAS-reaction and Giemsa. Histological assessment of the state of the gastric mucosa was carried out according to a modified Sydney system with an assessment of morphological changes according to a 4-point visual analog scale (0 to 3+).

Results. A total of 525 patients (301 men and 224 women) aged 15–80 years (median 39.8 ± 15.1 years) were examined. 239 (45.5 %) patients were diagnosed with chronic gastritis, chronic duodenitis (including erosive forms). In 286 (54.5 %) patients, peptic ulcer was diagnosed with localization in the stomach — in 42 (8 %), in the duodenum – in 238 (45.3 %), combined lesions — in 9 (1.7 %) cases. Based on the results of ¹³C-UDT DLS, H. рylori infection was detected in 447 patients. H. рylori was not found in erosive gastritis in 15 %, erosive duodenitis in 21 % and chronic non-erosive gastritis in 23 %. In peptic ulcer of the stomach and duodenum, H. pylori was detected in 93 % and 97 %.

A direct linear relationship between the results of the breath test and the quantitative content of H. рylori on the surface of the gastric mucosa was obtained. The parameters of laser ¹³C-UBT clearly correlate with the degree of severity of mononuclear infiltration of the mucosa (the strength of the connection is 0.78). When comparing the average values of laser ¹³C-UBT with the total assessment of the degree of mucosal neutrophilic infiltration, no significant relationship was found. With a slight severity of mucosal atrophy, the result of laser based ¹³C-UBT practically does not change; there is a tendency of a decrease in the breath test with an increase in atrophic changes.

Conclusion. Indicators of ¹³C-UBT correlate with the quantitative content of H. pylori bacteria in the gastric mucosa, the severity of mononuclear infiltration of the gastroduodenal mucous, the severity of atrophic changes. 

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