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Nissen LHC, Derikx LAAP, Jacobs AME, van Herpen CM, Kievit W, Verhoeven R, van den Broek E, Bekers E, van den Heuvel T, Pierik M, Rahamat-Langendoen J, Takes RP, Melchers WJG, Nagtegaal ID, Hoentjen F, Peutz-Kootstra C, Roelofs JJTH, Willems SM, Willig AP, van Bodegraven AA, Tan ACITL, Meeuse JJ, van der Meulen–de Jong AE, Oldenburg B, Loffeld BCAJ, Durfeld BM, van der Woude CJ, Cahen DL, D’Haens G, Janik D, Mares WGM, Gilissen LPL, Wolters FL, Dijkstra G, Erkelens GW, Tang TJ, Breumelhof R, Smalbraak HJT, Thijs JC, Voskuil JH, Kuyvenhoven JP, Vecht J, Rijk MCM, Janssen JM, Sarneel JT, Tjhie-Wensing JWM, Lai JYL, Vlasveld LT, Oostenbrug LE, Gerretsen M, Van Herwaarden MA, Mahmmod N, Russel MGVM, Grubben MJAL, Vu MK, Verhulst ML, Dewint P, Stokkers PCF, Bus PJ, Wismans PJ, van der Haeck PWE, Stuyt RJL, Zeijen RNM, Dahlmans RPM, Vandebosch S, Romkens TEH, Moolenaar W, ten Hove WR, Boot H, van der Linde K, Wahab P, de Boer SY, Thurnau K, Thijs WJ, Josemanders DFGM, West RL, Pierik MJ, Depla ACTM, Keulen ETP, de Boer WA, Naber AHJ, Vermeijden JR, Mallant-Hent RC, Beukers R, Ter Borg PCJ, Halet ECR, Bruin KF, Linskens RK, Bruins Slot W. Risk Factors and Clinical Outcomes of Head and Neck Cancer in Inflammatory Bowel Disease: A Nationwide Cohort Study. Inflamm Bowel Dis 2018; 24:2015-2026. [PMID: 30759216 DOI: 10.1093/ibd/izy096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immunosuppressed inflammatory bowel disease (IBD) patients are at increased risk to develop extra-intestinal malignancies. Immunosuppressed transplant patients show increased incidence of head and neck cancer with impaired survival. This study aims to identify risk factors for oral cavity (OCC) and pharyngeal carcinoma (PC) development in IBD, to compare clinical characteristics in IBD with the general population, and to assess the influence of immunosuppressive medication on survival. METHODS We retrospectively searched the Dutch Pathology Database to identify all IBD patients with OCC and PC between 1993 and 2011. Two case-control studies were performed: We compared cases with the general IBD population to identify risk factors, and we compared cases with non-IBD cancer patients for outcome analyses. RESULTS We included 66 IBD patients and 2141 controls with OCC, 31 IBD patients and 1552 controls with PC, and 1800 IBD controls. Age at IBD diagnosis was a risk factor for OCC development, Crohn's disease (CD; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.07), and ulcerative colitis (UC; OR, 1.03; 95% CI, 1.01-1.06). For PC, this applied to UC (OR, 1.05; 95% CI, 1.01-1.06). IBD OCC cases showed impaired survival (P = 0.018); in PC, survival was similar. There was no effect of immunosuppression on survival. Human papillomavirus (HPV) testing of IBD cases revealed 52.2% (12/23) HPV-positive oropharyngeal carcinomas (OPCs). CONCLUSION This study shows that IBD is associated with impaired OCC survival. Higher age at IBD diagnosis is a risk factor for OCC development. We found no influence of immunosuppression on survival; 52.2% of OPC in IBD contained HPV.
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Affiliation(s)
- Loes H C Nissen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology.,Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | | | - Anouk M E Jacobs
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology
| | - Carla M van Herpen
- Department of Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rob Verhoeven
- Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organization
| | | | - Elise Bekers
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tim van den Heuvel
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marieke Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Robert P Takes
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology
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Ahmed Ali U, Issa Y, van Goor H, van Eijck CH, Nieuwenhuijs VB, Keulemans Y, Fockens P, Busch OR, Drenth JP, Dejong CH, van Dullemen HM, van Hooft JE, Siersema PD, Spanier BWM, Poley JW, Poen AC, Timmer R, Seerden T, Tan AC, Thijs WJ, Witteman BJM, Romkens TEH, Roeterdink AJ, Gooszen HG, van Santvoort HC, Bruno MJ, Boermeester MA. Dutch Chronic Pancreatitis Registry (CARE): design and rationale of a nationwide prospective evaluation and follow-up. Pancreatology 2014; 15:46-52. [PMID: 25511908 DOI: 10.1016/j.pan.2014.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/30/2014] [Accepted: 11/14/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic pancreatitis is a complex disease with many unanswered questions regarding the natural history and therapy. Prospective longitudinal studies with long-term follow-up are warranted. METHODS The Dutch Chronic Pancreatitis Registry (CARE) is a nationwide registry aimed at prospective evaluation and follow-up of patients with chronic pancreatitis. All patients with (suspected) chronic or recurrent pancreatitis are eligible for CARE. Patients are followed-up by yearly questionnaires and review of medical records. Study outcomes are pain, disease complications, quality of life, and pancreatic function. The target sample size was set at 500 for the first year and 1000 patients within 3 years. RESULTS A total of 1218 patients were included from February 2010 until June 2013 by 76 participating surgeons and gastroenterologist from 33 hospitals. Participation rate was 90% of eligible patients. Eight academic centers included 761 (62%) patients, while 25 community hospitals included 457 (38%). Patient centered outcomes were assessed by yearly questionnaires, which had a response rate of 85 and 82% for year 1 and 2, respectively. The median age of patients was 58 years, 814 (67%) were male, and 38% had symptoms for less than 5 years. DISCUSSION The CARE registry has successfully recruited over 1200 patients with chronic and recurrent pancreatitis in about 3 years. The defined inclusion criteria ensure patients are included at an early disease stage. Participation and compliance rates are high. CARE offers a unique opportunity with sufficient power to investigate many clinical questions regarding natural course, complications, and efficacy and timing of treatment strategies.
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Affiliation(s)
- U Ahmed Ali
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Y Issa
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - H van Goor
- Department of Surgery, RadboudUMC, Nijmegen, Netherlands
| | - C H van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Y Keulemans
- Department of Gastroenterology, Maastricht University Medical Center, Maastricht, Netherlands
| | - P Fockens
- Department of Gastroenterology, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - O R Busch
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - J P Drenth
- Department of Gastroenterology, RadboudUMC, Nijmegen, Netherlands
| | - C H Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - H M van Dullemen
- Department of Gastroenterology, University Medical Center Groningen, Groningen, Netherlands
| | - J E van Hooft
- Department of Gastroenterology, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - P D Siersema
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, Netherlands
| | - B W M Spanier
- Department of Gastroenterology, Rijnstate Hospital, Arnhem, Netherlands
| | - J W Poley
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, Netherlands
| | - A C Poen
- Department of Gastroenterology, Isala Clinics, Zwolle, Netherlands
| | - R Timmer
- Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - T Seerden
- Department of Gastroenterology, Amphia Hospital, Breda, Netherlands
| | - A C Tan
- Department of Gastroenterology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - W J Thijs
- Department of Gastroenterology, Martini Hospital, Groningen, Netherlands
| | - B J M Witteman
- Department of Gastroenterology, Gelderse Vallei Hospital, Ede, Netherlands
| | - T E H Romkens
- Department of Gastroenterology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - A J Roeterdink
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - H G Gooszen
- Department of OR and Evidence Based Surgery, RadboudUMC, Nijmegen, Netherlands
| | - H C van Santvoort
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - M J Bruno
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
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Borş S, Karrenbeld A, Thijs WJ. A less common cause of diarrhoea. Neth J Med 2009; 67:401-402. [PMID: 20030004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- S Borş
- Department of Internal Medicine, Scheper Hospital Emmen, the Netherlands.
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Affiliation(s)
- W J Thijs
- Department of Internal Medicine and Gastroenterology, Scheper Ziekenhuis, Emmen, The Netherlands.
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de Graaf AP, Westerhof J, Weersma RK, Thijs WJ, Limburg AJ, Koornstra JJ. Correlation between predicted and actual consequences of capsule endoscopy on patient management. Dig Liver Dis 2008; 40:761-6. [PMID: 18394976 DOI: 10.1016/j.dld.2008.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 02/08/2008] [Accepted: 02/19/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is a relatively new diagnostic modality in the evaluation of patients with suspected small bowel pathology. It is unclear to what extent physicians are able to predict the clinical consequences of CE on patient management. METHODS In this prospective study, 180 consecutive CE examinations were analysed. Prior to CE, referring physicians were asked to indicate the consequences of CE according to potential different CE outcomes. The influence of CE on patient management was determined with at least 1 year follow-up. Management consequences were defined as major (surgical or endoscopic intervention, or medical therapy) or minor (nonspecific therapy, including iron supplementation, or no further diagnostic tests). RESULTS CE led to major management consequences in 32% of cases. Of patients with obscure gastrointestinal bleeding and normal CE findings, 91% were independent of blood transfusions and experienced no further bleeding episodes during a mean follow-up of 33 months. In 78% of 118 cases that were evaluated, the actual consequences of CE matched the consequences predicted by the referring physicians. CONCLUSION CE had a major impact on patient management in about one third of investigations. In the majority of cases, physicians adequately predicted the clinical consequences of CE.
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Affiliation(s)
- A P de Graaf
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Affiliation(s)
- R K Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, The Netherlands
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Affiliation(s)
- W J Thijs
- Department of Internal Medicine and Gastroenterology, Scheperziekenhuis, Emmen, The Netherlands.
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Thijs WJ, Kleibeuker JH. [Screening for coeliac disease currently not indicated]. Ned Tijdschr Geneeskd 2005; 149:797-800. [PMID: 15850269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Coeliac disease is a common disorder, but most persons with coeliac disease remain undetected because they have only mild aspecific symptoms or are free of symptoms. For a definitive diagnosis small bowel biopsies showing partial or (sub)total villous atrophy are required. The presence of anti-endomysium and/or anti-tissue-transglutaminase antibodies in serum is strongly predictive for coeliac disease. In case of clear clinical suspicion the most straightforward way to diagnose or exclude coeliac disease is by taking endoscopic biopsies from the distal duodenum. When the suspicion is low, determination of the above mentioned antibodies as a first step suffices. At present there are insufficient reasons to initiate population-wide screening for coeliac disease by means of serological testing or individual screening by taking duodenal biopsies during each gastroscopy.
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Affiliation(s)
- W J Thijs
- Universitair Medisch Centrum Groningen, 9700 RB Groningen
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Thijs WJ, van Baarlen J, Kleibeuker JH, Kolkman JJ. Microscopic colitis: prevalence and distribution throughout the colon in patients with chronic diarrhoea. Neth J Med 2005; 63:137-40. [PMID: 15869041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Microscopic colitis presents with chronic diarrhoea with or without abdominal pain. Microscopic colitis is an important cause of chronic diarrhoea. It can be distributed throughout the colon, as well as limited to the right colon. Microscopic colitis is associated with coeliac disease. We studied the prevalence and distribution of microscopic colitis in patients with diarrhoea and normal colonoscopy and we studied the association with coeliac disease. METHODS Colonoscopy was performed. Biopsies were taken from every segment of the colon. Lymphocytic colitis was defined as the presence of more than 20 lymphocytes per 100 epithelial cells and collagenous colitis was defined as thickening of the basal membrane of more than 10 microm. Upper endoscopy was performed if upper intestinal symptoms were present. If this was the case, small bowel biopsies were taken. RESULTS Microscopic colitis was found in 13 out of 103 patients. The distribution was diffuse throughout the colon in ten and restricted to the right colon in three patients. In seven patients, upper endoscopy was performed. Marsh I/II lesions were found in six out of seven patients. CONCLUSION Microscopic colitis was limited to the right colon in 23% of patients. Biopsies of macroscopically normal colonic mucosa in patients with diarrhoea is mandatory.
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Affiliation(s)
- W J Thijs
- Departments of Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands.
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Thijs WJ, Koornstra JJ, Karrenbeld A, Limburg AJ. [Eosinophilic oesophagitis in young men with food swallowing complaints]. Ned Tijdschr Geneeskd 2005; 149:653-6. [PMID: 15813433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Three men, aged 20, 24 and 42 years, reported difficulties in passing food through the oesophagus. The diagnosis of eosinophilic oesophagitis was made after endoscopic investigation, laboratory tests and histological tests. In all three patients the symptoms disappeared: respectively spontaneously, during systemic treatment with corticosteroids due to a kidney complaint, and after topical corticosteroid treatment lasting 6 weeks. Eosinophilic oesophagitis occurs in particular in young men. There are complaints about the passage of food through the oesophagus, with frequent food impaction, also without any obvious stenosis. Endoscopic features are subtle and comprise a vulnerable oesophageal mucosa with a ringed appearance or small white spots on the oesophageal mucosa. Histopathology reveals an eosinophilic infection infiltrate in the oesophageal epithelium. Food allergies may play a causal role. With respect to the treatment, favourable results have been described for oral fluticasone, while endoscopic treatment may consist of dilation.
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Affiliation(s)
- W J Thijs
- Afd. Maag-, Darm- en Leverziekten, Universitair Medisch Centrum Groningen, Postbus 30.001, 9700 RB Groningen
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Abstract
BACKGROUND AND STUDY AIMS In the past, small-bowel biopsies for diagnosis of celiac disease were taken from the jejunum with a suction capsule, but nowadays most physicians take endoscopic biopsies from the distal duodenum. To validate that practice we compared the diagnostic yield of endoscopic duodenal biopsies with that of endoscopic jejunal biopsies. In addition, we describe a method of orienting biopsy specimens optimally. PATIENTS AND METHODS Upper endoscopy was performed with a colonoscope. Four jejunal and four duodenal biopsies were taken and oriented immediately thereafter. The pathologist rated the orientation as poor, adequate, or good, and histopathological results were expressed according to the Marsh classification. Jejunal and duodenal biopsy results were compared. RESULTS 146 patients were included. Jejunal biopsies were taken in 142 patients, and Marsh I-II lesions were found in 56 and Marsh III lesions in 15 patients. In three patients duodenal biopsies were normal while jejunal biopsies showed Marsh I-II lesions. No discrepancies were found in patients with Marsh III lesions. Orientation was good in all biopsies. CONCLUSION Duodenal biopsies are sufficient to diagnose full-blown celiac disease (Marsh III), but Marsh I-II lesions may be missed in some cases.
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Affiliation(s)
- W J Thijs
- Department of Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands.
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Thijs JC, Van Zwet AA, Thijs WJ, Van der Wouden EJ, Kooy A. One-week triple therapy with omeprazole, amoxycillin and tinidazole for Helicobacter pylori infection: the significance of imidazole resistance. Aliment Pharmacol Ther 1997; 11:305-9. [PMID: 9146767 DOI: 10.1046/j.1365-2036.1997.155329000.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Triple therapy involving a proton pump inhibitor and two antibiotics has been suggested as an effective treatment for Helicobacter pylori infection. The impact of imidazole resistance on the efficacy of such regimens is largely unknown. METHODS One hundred patients with culture proven H. pylori infection were treated with omeprazole 40 mg b.d., amoxycillin 1000 mg b.d., and tinidazole 500 mg b.d. for one week. Pre-treatment imidazole susceptibility was measured by disk diffusion. Resistance was confirmed by E-test. Eradication was assessed by endoscopy 6-8 weeks after the end of treatment. In cases of doubt a 13C-urea breath test was performed. Side-effects were scored using a semiquantitative scale. RESULTS H. pylori was eradicated in 95% of the patients with an imidazole-susceptible strain and in 69% of the patients with a resistant strain (P < 0.005). Significant side-effects were seen in 12%. CONCLUSION This proton pump inhibitor triple therapy is a simple, reasonably effective regimen with few significant side-effects. The efficacy is dependent on the susceptibility of the infecting H. pylori strain.
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Affiliation(s)
- J C Thijs
- Department of Internal Medicine, Bethesda Hospital, Hoogeveen, The Netherlands
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Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH. Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard. Am J Gastroenterol 1996. [PMID: 8855734 DOI: 10.1016/0016-5085(95)23623-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the accuracy of six commonly used diagnostic tests for Helicobacter pylori in a prospective study without using any specific test as the gold standard (the patient was regarded as H. pylori-infected if two or more tests, whatever their nature, were positive). METHODS In 105 outpatients undergoing upper GI endoscopy, 62 without significant abnormalities, 28 with gastroesophageal reflux disease, 19 with peptic ulcer, one with erosive gastritis, and one with atrophic gastritis (some patients had more than one diagnosis), antral biopsy specimens were taken for culture, polymerase chain reaction, histological examination (hematoxylineosin and Giemsa stains), and rapid urease test. Corpus biopsy specimens were taken for histological examination. Serology (ELISA) and a 13C-urea breath test were also performed. Consistency of diagnosis between two pathologists was assessed by kappa statistics. RESULTS Sensitivity and specificity, respectively, were as follows: culture, 98.4 and 100%; polymerase chain reaction, 96.7 and 100%; histological examination (antrum), 96 and 98.8%; histological examination (antrum + corpus), 98.4 and 98.8%; rapid urease test, 90.2 and 100%; 13C-urea breath test, 100 and 100%; and serological examination, 98.4 and 88.4% (95% in those who had not been previously treated for H. pylori). All H. pylori-positive cases were detected by culture and rapid urease test. In 86.4% of these cases all antral biopsy-based tests were positive. Agreement between pathologists was good, with a kappa coefficient around 0.90 for antral biopsy specimens. CONCLUSIONS All antral biopsy-based tests, as well as the 13C-urea breath test, are accurate for the diagnosis of H. pylori infection. Sampling error is a problem of minor importance. The lower specificity of serological tests may be largely explained by previous treatment of H. pylori.
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Affiliation(s)
- J C Thijs
- Department of Internal Medicine, Bethesda Hospital, Hoogeveen, The Netherlands
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14
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Thijs WJ, Thijs JC, Kleibeuker JH, Elzinga H, Stellaard F. Evaluation of clinical and home performance of the 13C-urea breath test for the detection of Helicobacter pylori. Eur J Gastroenterol Hepatol 1995; 7:603-7. [PMID: 8590153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study analyses the 13C-urea breath test with the aim of determining the optimal time interval between dosing and breath sampling and examines the feasibility of having patients perform the test without supervision at home. DESIGN Prospective study comparing the 13C-urea breath test with four antral biopsy-based tests in a random population undergoing upper gastrointestinal endoscopy. SETTING One university hospital and one general hospital. PATIENTS One hundred and four patients were included; 61 were Helicobacter pylori-positive and 43 H. pylori-negative according to biopsy-based tests. INTERVENTIONS The 13C-urea breath test was performed at home by collecting a baseline and two post-dosing samples; the next day it was performed clinically by collecting a baseline and six post-dosing samples. A 100 mg dose of 13C-urea and a test meal were used. OUTCOME MEASURES The breath samples collected were analysed. Excess delta 13CO2/12CO2 values above five per million were considered positive. RESULTS The specificity of the clinical test was 100% whereas that of the home-based test was 95.1%. The sensitivity of the clinical test depended on the time interval between dosing and collection of the evaluated sample. Sensitivity was 100% if the sample was taken 50 min or more after dosing. The home-based test had a sensitivity of 94.8%. CONCLUSION To obtain maximum sensitivity (100%) using the single-sample technique the sample has to be collected at least 50 min after dosing. It is feasible to have the test performed at home. Patient selection and thorough instruction are necessary.
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Affiliation(s)
- W J Thijs
- Department of Gastroenterology, University Hospital, Groningen, Netherlands
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