13C urea breath test to identify Helicobacter pylori Infection in patients with upper gastrointestinal bleeding admitted to the Emergency Department

OBJECTIVE: Upper gastrointestinal bleeding (UGIB) is a cause of Emergency Department (ED) visits. Peptic ulcer secondary to H.pylori (HP) infection and/or to the use of NSAIDsis the most frequent cause. The aim of the studyis to evaluate directly in the ED the prevalence ofHP infection through Urea Breath test (UBT) inpatients admitted to the ED for UGIB.PATIENTS AND METHODS: We enrolled 87 patients (58M/29F) with a mean age of 63.8 + 11.7yrs with an active UGIB who performed EGDSand UBT.RESULTS: 34.4% of patients performing EGDSand UBT resulted positive to HP. Peptic ulcer waspresent in 20/30 (66.7%) of HP+ compared to 20/57(35.1%) of HP- (p<0.001), and also gastritis and/orduodenitis were mostly present in HP+ (23.3% vs.15.8%) (p<0.05). A biopsy was performed in only31% of patients with a positive rate of 33.3%. In 78%we obtained a correspondence between UBT andbiopsy results. Compared to biopsy result, we obtained for UBT a positive predictive value (PPV) of71% and a negative predictive value (NPV) of 80%.Taking the UBT as a gold standard, we obtained forbiopsies a PPV of 69% and a NPV of 85%.CONCLUSIONS: Our study confirms that theuse of UBT directly in ED in patients with UGIB allows for a rapid, reliable and non-invasive diagnosis of HP infection as a causative agent for bleeding, thus permitting a right etiological treatment.