Wroblewski: Does the urea breath test tell us what we need to know? [CMAJ

Does the urea breath test tell us what we need to know?

CMAJ 2000;162:1401

See response from: C.A. Fallone, et al

The Feb. 8th issue of CMAJ had an interesting article by Carlo Fallone and colleagues concerning the urea breath test for Helicobacter pylori infection [Review],¹ interesting not only for what the test will detect but for what tests it may push to the sidelines. There is certainly talk of the urea breath test lessening the need for gastroscopy, something that is welcomed as a means to cut costs and decrease patient discomfort and morbidity. But it does mean fewer chances to pick up premalignant lesions or early frank carcinoma. Protocols surrounding the urea test recommend scoping only when alarm signs appear, but clinical signs and symptoms are often the herald of higher stage disease. As a pathologist, all too often I see carcinoma cases from all parts of the GI tract presenting on the cutting table as advanced, node-positive disease.

It seems to me that at present we are not scanning, scoping or poking enough to detect the early, treatable malignancies. If our present diagnostic modalities are too expensive or risky for this more rigorous hunting, then surely more resources must be devoted to some sort of revolution in diagnostic imaging or direct visualization technology. Tasting and smelling for disease are no substitute for looking.

Julius A. Wroblewski
Mount St. Joseph Hospital
Vancouver, BC

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Reference

Fallone CA, Veldhuyzen van Zanten SJO, Chiba N. The urea breath test for Helicobacter pylori infection: taking the wind out of the sails of endoscopy. CMAJ 2000;162(3):371-2.