El-Nujumi A, Hilditch T E, Williams C, McColl K E
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
Eur J Gastroenterol Hepatol. 1998 Sep;10(9):759-64. doi: 10.1097/00042737-199809000-00006.
There are increasing indications for assessing Helicobacter pylori status by non-invasive means in dyspeptic patients. There is also increasing use of proton pump inhibitor therapy for dyspeptic disease.
To determine the effect of proton pump inhibitor therapy on the accuracy of the [14C]urea breath test.
[14C]Urea breath tests were performed in 20 H. pylori-positive and 13 H. pylori-negative dyspeptic patients before commencing omeprazole and after 4 weeks of treatment with 40 mg/day and then 6 months of treatment with 20 mg/day. Further studies were done in H. pylori-positive patients to examine the time course of the onset and resolution of the effect observed.
False negative results occurred in 45% of the H. pylori-positive subjects after 4 weeks of omeprazole 40 mg/day and in 28% after 6 months of 20 mg/day. False positive results occurred in 15% of the H. pylori-negative subjects after 4 weeks of omeprazole 40 mg/day. In the H. pylori-positive subjects time course studies showed increasing suppression of the breath test result over the first 2-4 weeks of treatment. It took a similar time for the breath test result to recover after stopping treatment. There was no significant change in H. pylori IgG serology in the H. pylori-positive patients after 7 months of omeprazole treatment.
Proton pump inhibitor therapy markedly impairs the accuracy of the [14C]urea breath test and, in particular, produces a high proportion of false negative results. The effect is dose related and may persist for 2-4 weeks after stopping therapy. Patients should be carefully questioned about recent proton pump inhibitor therapy before accepting a negative breath test result as reliable.
越来越多的迹象表明，通过非侵入性手段评估消化不良患者的幽门螺杆菌状况很有必要。质子泵抑制剂疗法在消化不良疾病中的应用也越来越广泛。
确定质子泵抑制剂疗法对[14C]尿素呼气试验准确性的影响。
20例幽门螺杆菌阳性和13例幽门螺杆菌阴性的消化不良患者在开始使用奥美拉唑之前以及接受40毫克/天治疗4周、然后20毫克/天治疗6个月后进行了[14C]尿素呼气试验。对幽门螺杆菌阳性患者进行了进一步研究，以观察所观察到的效应的发生和消退的时间进程。
在每天服用40毫克奥美拉唑4周后，45%的幽门螺杆菌阳性受试者出现假阴性结果；在每天服用20毫克6个月后，28%的受试者出现假阴性结果。在每天服用40毫克奥美拉唑4周后，15%的幽门螺杆菌阴性受试者出现假阳性结果。在幽门螺杆菌阳性受试者中，时间进程研究显示，在治疗的前2至4周内，呼气试验结果的抑制作用逐渐增强。停药后呼气试验结果恢复也需要类似的时间。奥美拉唑治疗7个月后，幽门螺杆菌阳性患者的幽门螺杆菌IgG血清学无显著变化。
质子泵抑制剂疗法显著损害[14C]尿素呼气试验的准确性，尤其是会产生高比例的假阴性结果。这种效应与剂量相关，停药后可能持续2至4周。在将呼气试验阴性结果视为可靠结果之前，应仔细询问患者近期是否接受过质子泵抑制剂治疗。
