13C-urea breath test for diagnosis of Helicobacter pylori infection in the elderly

Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the C-13-urea breath test (C-13-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The C-13-UBT was performed with 75 mg urea labeled with C-13. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70-102 years, 958 (45%) men, referred for C-13-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive C-13-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for C-13-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.