Medical guidance: Chief Physician of the Department of Gastrointestinal Surgery of Zhongshan First Hospital, Ma Jinping
Medical Expertise: Good at gastrointestinal surgery clinical common gastric cancer standards and expanded radical resection, colon cancer laparoscopic surgery at various sites, TME radical resection of rectal cancer, functional radical resection of rectal cancer, surgical treatment of benign and malignant diseases of the pancreas, familiar with surgery such as pancreatic duodenal resection, radical treatment of middle and lower esophageal cancer, surgical treatment of benign and malignant tumors of the duodenum, and various surgical treatments of inguinal hernias and incisional hernias.
Helicobacter pylori has been identified as one of the carcinogenic factors of gastric cancer, so many patients with gastrointestinal problems often have the "Helicobacter pylori" examination item when they go to the hospital to see a doctor.
There are many ways to detect Helicobacter pylori, among which the "blowing method (exhalation test)" is particularly favored by the people.
Opening a mouth to blow air can easily detect Helicobacter pylori, such a convenient and less sinful examination, how can the people not like it.
So, can the breath test replace other tests such as gastroscopy and blood draw?
Helicobacter pylori (HP)
In 1994, the International Agency for Research on Cancer (IARC) listed Helicobacter pylori (Hp) as a Class I carcinogen, and HP infection has been confirmed to be the driving factor in the evolution of "chronic non-atrophic gastritis→ atrophic gastritis→ intestinal metaplasia → dysplasia → gastric cancer".
Once infected with Hp, it is difficult to heal itself without treatment. About 10% to 15% of hp-infected people will develop peptic ulcer, about 50% will develop gastric mucosal atrophy, and 2% to 3% of people infected with Hp will develop gastric malignancy. In addition, Hp infection is also associated with the occurrence of some extragastric disorders, such as unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura, which have been recommended as indications for hp eradication.
The key to eradicating Hp is "early detection." Commonly used test methods include gastroscopy, breath test, blood draw, genetic testing, etc.
(Image from the Internet)
"Blowing method" (exhalation test)
The real name of the "blowing method" is: 13C (or 14C) urea breath test, hereinafter referred to as the breath test. 13C is a stable isotope that occurs naturally in specific proportions in nature and is suitable for subjects of all ages and types, including pregnant women and children. It is recognized at home and abroad that 13C has a high degree of accuracy in diagnosing Hp infection and judging the efficacy of Hp eradication, and there is a tendency to replace 14C, but the price is more expensive. The same principle of 14C testing is inexpensive, but radioactive, and cannot be used in pregnant women and people and children who are trying to become pregnant in the near future.
First, the principle
Isotopes of carbon (14C or 13C) are used to label carbon atoms in urea, and the urease produced by Helicobacter pylori will decompose the labeled urea into carbon dioxide and ammonia, the labeled carbon atoms in the urea will be moved to carbon dioxide, and the carbon dioxide will be discharged from the lungs through blood circulation, and then the carbon dioxide content will be measured by breathing to determine the presence or absence of Helicobacter pylori.
Second, the inspection steps
Before the examination, the subject needs to take a capsule on an empty stomach for 3 hours, exhale three breaths after half an hour to retain the sample, and measure the carbon dioxide content produced by the decomposition of Helicobacter pylori through a specific instrument to more accurately detect the presence of Helicobacter pylori infection. To avoid a "false-negative" result (i.e., one that was originally there but not detected), patients need to discontinue PPI (proton pump inhibitors) 2 weeks before the test or stop antimicrobials 4 weeks before the test; bleeding symptoms can cause false negative results, and the presence of other urease-producing pathogens in the stomach can also lead to "false positive" results (i.e., those that were not originally detected) can also lead to "false positives" results (i.e., those that were not originally there were detected).
Advantages of the blowing method
First, accurate
Gastroscopic detection of Helicobacter pylori often requires the removal of a part of the "suspicious lesion" gastric mucosal tissue sample, there is a certain probability of missed examination (because it is impossible to take the entire gastric tissue for examination), if the material site is just not found Helicobacter pylori, it will cause missed diagnosis. The blowing method overcomes this deficiency and can make an overall assessment of Helicobacter pylori infection in the stomach, regardless of the distribution of lesions. The sensitivity and specificity of the blowing method are high, and in some cases it can already replace gastroscopy, such as follow-up after radical treatment of Helicobacter pylori. It is currently recognized as one of the gold standards for Helicobacter pylori testing.
Second, convenient and painless
Open your mouth and blow a few breaths, what is the effort? And do not have to experience all kinds of discomfort of gastroscopy, which can save the people a lot of heart. Especially after radical treatment of Helicobacter pylori, the effect of treatment can be reviewed by breath test, but it should be noted that it is necessary to repeat the drug after 1 month after stopping the drug, otherwise it will affect the authenticity of the test results.
Disadvantages of the "blowing method"
1. Radioactivity
14C is radioactive and cannot be used in pregnant women and people and children who are trying to become pregnant in the near future.
Second, the inspection results are easily disturbed
The results of the blowing method are susceptible to interference from drugs, bleeding symptoms, other pathogens, etc., which may cause misdiagnosis and missed diagnosis.
Third, the ability to evaluate stomach disease is limited
The breath test can only determine whether there is Helicobacter pylori infection and does not confirm the associated disease.
The breath test is not a substitute for gastroscopy
Although the breath test can accurately determine the presence or absence of Helicobacter pylori in the stomach, it is not an easy substitute for gastroscopy. The breath test can only detect whether there is Helicobacter pylori infection, and a negative result does not mean that there is no stomach disease, and the relationship between Helicobacter pylori and stomach disease is not simply equated.
Gastroscopy is closely related to the evaluation of stomach disease, which can detect whether it is infected with Helicobacter pylori, but also determine whether there is inflammation, ulcers, polyps and tumors in the stomach.
Therefore, although the breath test plays an important role in the detection of Helicobacter pylori, "blowing breath" can make some Helicobacter pylori "appear", but it can not replace gastroscopy, and there is a complementary relationship between the two. In some cases, in addition to "blowing breath", it is also necessary to "suffer" to do gastroscopy to better diagnose the disease.
Blowing breath can find Helicobacter pylori, so do you still have to suffer to do gastroscopy? ------ The 1807th Post of Lan Shiting Medical and Health Science Popularization
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