Digestive Diseases and Sciences, Vol. 49, Nos. 11/12 (November/December 2004), pp. 1840–1844 ( C  2004) 13 C-Urea Breath Test for Diagnosis of Helicobacter pylori Infection in the Elderly YARON NIV, MD, GALIA NIV, MSc, RN, and RIVKA KOREN, BSc Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treat- ment 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 13 C-urea breath test ( 13 C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13 C-UBT was performed with 75 mg urea labeled with 13 C. Physicians who ordered the test completed a question- naire 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 13 C-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 13 C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradi- cation therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13 C-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. KEY WORDS: Helicobacter pylori; geriatrics; eradication therapy; 13 C-urea breath test. Helicobacter pylori infection is highly prevalent in many countries and may cause chronic gastritis, peptic ulcer disease, cancer, and lymphoma (1, 2). Gastric acid secre- tion, atrophy, and intestinal metaplasia are related more to long-standing H. pylori infection than to age, but within the group of H. pylori-positive subjects, these parameters increase with age (3–6). Diagnosis of H. pylori infection remains difficult in elderly patients. Multiple hospitaliza- tions, antimicrobial therapy for urinary tract infection and pneumonia, or the presence of atrophic gastritis, (which provides a hostile environment for the bacterium) may lead to under diagnosis (7). Manuscript received May 25, 2004; accepted July 16, 2004. From the Helicobacter Pylori Central Laboratory, Clalit Health Ser- vices (CHS), Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, and Tel Aviv University, Israel. Address for reprint requests: Prof. Yaron Niv, Department of Gas- troenterology, Beilinson Campus, Rabin Medical Center, Petach Tikva, 49100, Israel; yniv@clalit.org.il. In the elderly, peptic disease and complications such as upper gastrointestinal bleeding have a greater associa- tion with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin than with H. pylori infection (8). A large cohort study of peptic ulcer disease in the elderly reported only a 26% rate of H. pylori positivity, compared to an 82% rate of recent use of NSAIDs (8). Thus, eval- uation of peptic disease in the elderly should include the parameters of H. pylori infection and NSAID therapy. The synergism of H. pylori gastritis and NSAID gastropathy in peptic disease pathology was recently established by a meta-analysis, as well as by a prospective, controlled study (9, 10). Physicians should be able to diagnose H. pylori infec- tion with a highly sensitive and specific method, when in- dicated. The 13 C-urea breath test ( 13 C-UBT) has the high- est sensitivity of the noninvasive tests, also in the elderly (7). Exhaled air is collected before and after swallowing 13 C-urea, and the 13 C/ 12 C ratio is measured with a mass 1840 Digestive Diseases and Sciences, Vol. 49, Nos. 11/12 (November/December 2004) 0163-2116/04/1200-1840/0 C  2004 Springer Science+Business Media, Inc.