14C urea breath test does not predict density of Helicobacter pylori in duodenal ulcer disease.

BACKGROUND & OBJECTIVES: The density of Helicobacter pylori in the gastric mucosa has prognostic significance, higher densities being associated with greater chances of development of duodenal ulcer and chronic atrophic gastritis as well as poor eradication by drug therapy. The aim of this study was to assess if 14C-urea breath test counts reflect bacterial density. METHODS: Sixty patients with endoscopically proven active duodenal ulcer and H. pylori positivity as determined by rapid urease test and gastric histology were studied. Gastric antral and corpus biopsies were graded for chronic gastritis, activity (presence of polymorphonuclear cells) and bacterial density (at surface and in pits) based on the Sydney system on a scale of four grades ranging from 0 to 3 (absent, mild, moderate and severe). 14C urea breath test was performed in all the patients. RESULTS: Chronic gastritis as well as activity was more prevalent as well as severe in the antrum as compared to the corpus. H. pylori density was also significantly more in the antrum as compared to the corpus both at the surface as well as in the pits. H. pylori density correlated with the grade of chronic gastritis and activity both in the antrum and in the corpus. Urea breath test counts ranged from 331.3 cpm (counts per minute) to 8770.5 cpm and these did not correlate with histological H. pylori density at any of the sites. INTERPRETATION & CONCLUSIONS: 14C urea breath test does not reflect H. pylori density on histology in patients of duodenal ulcer disease.