Diagnostic Value of 14C Urea Breath Test for Helicobacter pylori Detection Compared by Histopathology in Indonesian Dyspeptic Patients

Muhammad Miftahussurur,1,2 Adinta Windia,1 Ari Fahrial Syam,3 Iswan Abbas Nusi,1 Ricky Indra Alfaray,2,4 Kartika Afrida Fauzia,2,4 Hartono Kahar,5 Herry Purbayu,1 Titong Sugihartono,1 Poernomo Boedi Setiawan,1 Ummi Maimunah,1 Ulfa Kholili,1 Husin Thamrin,1 Amie Vidyani,1 Dalla Doohan,2 Langgeng Agung Waskito,2 Yudith Annisa Ayu Rezkitha,2,6 Gontar Alamsyah Siregar,7 Yoshio Yamaoka1,4 1Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia; 2Institute of Tropical Disease, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia; 3Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia; 4Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, 879-5593, Japan; 5Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia; 6Faculty of Medicine, University of Muhammadiyah Surabaya, Surabaya, East Java, 60113, Indonesia; 7Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Sumatra Utara, Medan, 20155, IndonesiaCorrespondence: Muhammad MiftahussururGastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Jalan Mayjend Prof. Dr. Moestopo No. 6– 8, Surabaya, 60286, IndonesiaTel/Fax +6231-502-3865Email muhammad-m@fk.unair.ac.idPurpose: Histopathology method is often used as a gold standard diagnostic for Helicobacter pylori infection in Indonesia. However, it requires an endoscopic procedure which is limited in Indonesia. A non-invasive method, such as 14C Urea Breath Test (UBT), is more favorable; however, this particular method has not been validated yet.Patients and Methods: A total of 55 dyspeptic patients underwent gastroscopy and 14C-UBT test. We used Heliprobe® UBT for UBT test. As for the histology, May-Giemsa staining of two gastric biopsies (from the antrum and corpus) were evaluated following the Updated Sydney System.Results: The Receiver Operating Characteristics analysis showed that the optimum cut-off value was 57 with excellence Area under Curve = 0.955 (95% CI = 0.861– 1.000). By applying the optimum cut-off value, Heliprobe® UBT showed 92.31% for sensitivity, 97.62% for specificity, 92.31% for positive predictive value, 97.62% for negative predictive value, 38.77 for positive likelihood ratio, 0.0788 for negative likelihood ratio, and 96.36% for the accuracy.Conclusion: The 14C-UBT is an accurate test for H. pylori diagnosis with excellent sensitivity, specificity, and accuracy. The different optimum cut-off points suggested that a validation is absolutely necessary for new test prior application to the new population.Keywords: Helicobacter pylori, UBT, diagnostic, infectious diseas