Persistent or Recurrent Peptic Ulcer in Patients with Negative Urea Breath Test after H. Pylori Eradication and Proton Pump Inhibitor Therapy

Background and Aims: For patients with Helicobacter pylori (H. pylori) infection-related peptic ulcer, urea breath test (UBT) is usually performed to evaluate the success of H. pylori eradication therapy. Follow-up esophagogastroduodenoscopy is not a routine practice after treatment. This study aims to elucidate the possibility of active peptic ulcers in the patients with negative result of UBT following H. pylori eradication and proton pump inhibitor (PPI) therapy. Materials and Methods: A total of 165 patients with peptic ulcer (gastric and duodenal ulcers) and H. pylori infection were consecutively enrolled between June 2009 and November 2010. Endoscopic biopsy, rapid urease test (RUT) and 14C-UBT were performed in all patients before and after 1 week of standard triple H. pylori eradication therapy and an 8-week course of PPI treatment. Results: Pre-treatment 14C-UBT values could not predict the success of H. pylori eradication therapy. After treatment, active duodenal ulcers were found in 23.5% of patients with a positive follow-up UBT result, while active duodenal ulcers were present in 9.8% patients with a negative follow-up UBT result (p = 0.20). In the multivariate analysis, old age (＞65 years) was the most important factor for persistence of active peptic ulcers in patients with negative follow-up UBT results (odds ratio [OR]=7.3, 95% confidence interval =2.09-25.44, p = 0.002). Conclusions: Pretreatment 14C-UBT values could not predict the success of H. pylori eradication therapy. After H. pylori eradication and 8-week PPI treatment, active peptic ulcers could still be discerned by endoscopy in 9.8% patients whose follow-up UBT results were negative. Old age (＞65 years) might be the single most important factor for persistence of active peptic ulcers in these patients.