oesophagogastroduodenal diseases: selective questions

Introduction: Motility disorders can be an important factor in the occurrence of symptoms of of dyspepsia that consequently require evaluation of clinical significance of noninvasive diagnostic approaches when observing patients with functional dyspepsia (FD), gastroesophageal reflux disease (GERD), and Helicobacter pylori-associated diseases of the stomach and duodenum. Aim: To determine the relationship between various motility disorders and to improve the diagnostics and treatment with the use of 13C-urea (UBT) and 13C-octanoic breath tests (OBT). Material and methods: A total of 591 patients, aged 18–83 years, who underwent upper gastrointestinal endoscopy at our department were evaluated. Age, sex, and duration of symptoms of dyspepsia were recorded. UBT and OBT were examined in patients with dyspepsia, GERD, and H. pylori-associated diseases. Results: Patients with dyspepsia syndrome had H. pylori infection in 70 ±1.3% of cases. The strategy of “test-and-treat” using UBT can be applied in 76.5% of cases of unexplained dyspepsia in the Ukrainian population. In patients with GERD, slowing down of the gastric emptying (GE) prevails (overall 79.7 ±4.4%), which is a reliable predictor of early relapse of GERD symptoms (OR = 4.9, 2.4–7.0). In the case of H. pylori-associated diseases, the slowing down of GE according to OBT data is a prognostic sign of the return of the symptoms of dyspepsia after successful eradication of H. pylori (OR = 2.1, 1.9–2.3). In H. pylori-associated diseases with a slow GE, recurrence of dyspeptic syndrome after H.pylori-eradication therapy is observed in 33.1% of cases; the appointment of prokinetics reduces this probability to 9.2% (p = 0.0074). Conclusions: Investigations into the clinical use of new facilities of 13C-breath tests in gastroenterology are shown. The clinical efficacy of urea and octanoic breath tests in FD, GERD, and H. pylori-associated diseases was proven experimentally among patients of the Ukrainian population. New simplified diagnostic and treatment approaches were proposed for certain groups of patients with gastric dyspepsia syndrome, based on the results of the UBT and the OBT. Introduction Gastroenterology is currently developing at a rapid pace and constantly presents new challenges and tasks to practitioners and scientists. The methods of visualisation of internal organs (endoscopy, capsular endoscopy, magnetic resonance and computer tomography, positron emission tomography, ultrasound scanning) have reached their greatest development today. A somewhat more complicated situation has arisen with regard to methods for evaluating the functional state of the organs of the digestive system because their diagnostic accuracy depends on many factors, and in order to increase the accuracy of the investigation it is often necessary to use a significant number of complementary diagnostic techniques. This stretches the diagnostic process over time and increases its cost. Many studies aimed at simplifying diagnostic algorithms for certain groups of gastroenterological patients are ongoing [1, 2]. Non-invasiveness and simplicity of implementation, together with safety, high efficacy, sensitivity, and specificity, have become requirements for diagnostic methods [1, 3]. Some of the most promising methods for the investigation of the gastrointestinal tract, the liver, and 2 Vadim Shypulin, Volodimir Chernyavskyi, Tetyana Nechypurenko, Artyom Neverovskyi, Lesya Gvozdecka, Natallya Mikhn’ova Gastroenterology Review the pancreas are so-called carbon or 13C-breath tests. The general principle for all breath tests based on the use of the 13C-isotope is that the patient takes a 13C-labeled substrate, which ultimately metabolises to CO2, which can be quantified in the exhaled air [4–6]. Today, one of these breath tests – the 13C-urea breath test (UBT) – has become generally accepted as the gold standard for the diagnosis of Helicobacter pylori (H. pylori) infection, due to its almost 100% sensitivity and specificity, and due to its non-invasiveness. It is officially recommended by international consensus (Maastricht V/Florence Consensus, 2016) as the method of choosing to diagnose the presence of H. pylori infection and assessing the effectiveness of eradication therapy. In our opinion, this allows us to investigate and introduce new simplified diagnostic and treatment algorithms for certain groups of patients with gastric dyspepsia syndrome, based on the results of UBT, without the use in most cases of endoscopy or investigation of acid-forming function of the stomach. Another test available in Ukraine that can be used to assess the functional state of the oesophagogastroduodenal zone is the 13C-octanoic breath test (OBT), which allows assessment of the gastric emptying function (because motility disorders can be the main factor in the occurrence of symptoms of dyspepsia) [3, 6, 7–9]. The investigation of 13C-OBT as a method of objectification of indications for medical correction of motor activity and evaluation of the effectiveness of treatment with prokinetic drugs is highly relevant.