Efficacy of non-invasive ammonium test in diagnostic of Helicobacter pylori infection in patient with dyspepsia


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Abstract

Detection of Helicobacter pylori (Hp) is mandatory examination for all patients with dyspepsia. An option for cost-effective non-invasive diagnosis of H. pylori infection is the HELIC® ammonium test (Association of Medicine and Analytics, St. Petersburg, Russia), based on the detection of ammonia (the second product of urea hydrolysis by Hp urease) in exhaled air in oral cavity. Material and methods. Three studies were conducted to assess the effectiveness of this test: 1. Evaluation of ammonia level increase in exhaled air before examination (basal level) and after direct infusion of 50 ml of 1% urea solution into stomach during endoscopic examination (loading level). In study, histological examination of stomach body and antrum biopsies was a reference comparison method. 2. Comparison of ammonium test results and histological method by independent researchers in different countries, 3. Analysis of the sensitivity and specificity of the ammonium test by independent researchers in different countries. Results. Eight patients out of nine with histologically confirmed Hp responded with a significant (p<0.001) increase in ammonia levels in oral cavity air after direct infusion of gastric mucosa with 1% urea solution. 2. The concordance of results of the ammonium test and histological examination occurred in 87.5% of cases in Russia (171 patients), 91.3% in Belarus (187patients), 92.4% in Azerbaijan (44 patients). 3. Sensitivity and specificity of the investigated method were 92% and 93% in Russia, 92.7% and 93.4% in Belarus, 91.5% and 92.6% in Azerbaijan, respectively. Conclusions. Non-invasive ammonium test has high level of sensitivity and specificity, high concordance of results with histological method results. Evidence has been obtained that ammonia formed in the stomach is transported through esophagus to the oral cavity where detection is available in a diagnostically significant amount. This test can be recommended for use in common clinical practice.

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About the authors

N. V Baryshnikova

Acad. I.P. Pavlov First Saint Petersburg State Medical University Institute of Experimental Medicine

Email: baryshnikova_nv@mail.ru
Candidate of Medical Sciences, Associate Professor

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