Dyspepsia is the most common gastrointestinal symptom in clinical practice. Approximately 44.7% patients with dyspepsia had gastritis or duodenitis diagnosed by endoscopic examination in Indonesia. Dyspepsia might be caused by two factors, infection and non-infection. Infection is mostly caused by Helicobacter pylori, whereas non-infection might be caused by stress, diet habits, hormonal factors and other functional factors. Detection of H. pylori infection could be performed by many ways, such as histological examination, stool antigen test, anti H. pylori antibody and urea breath test (UBT).
Gastritis, especially atrophic gastritis is the common contributing factor for gastric cancer. Inflammation of the gastric mucosa may cause loss of glands that will eventually be replaced by intestinal-type epithelial cells, which is considered as a low-grade dysplasia. This dysplastic tissue then become intestinal type gastric cancer as the end result of progressive changes in the gastric mucosa. Mechanism of gastritis induced by urease enzyme activity remains unclear. Urea and urease may increase mucosal damage due to increased ammonia level in the gastric mucosa. A study in mice given ammonia showed an increase in the number of inflammatory cells induced by chronic gastritis, suggesting a significant relationship between ammonia levels and gastritis.
Another study in patients with dyspepsia confirmed that ammonia levels were significantly associated with the severity of gastritis. In addition, peptic ulcer patients had significantly higher urease level than patients without peptic ulcers. It is suspected that there are urease-producing bacteria, including pathogens other than H. pylori which cause chronic gastritis in areas with low prevalence of H. pylori such as Indonesia. UBT is a non-invasive method to detect H. pylori which relied on the fact that H. pylori secretes urease enzyme which converts urea into ammonia and carbon dioxide. The UBT is a reliable method to detect H. pylori and performed based on the ability of H. pylori to break down urea, which is absorbed from the stomach and eliminated in exhalation. If the isotope is detected in the breath, the test is positive, suggesting H. pylori presence in the stomach. The amount of urease activity, detected by value from UBT may reflect the H. pylori bacterial load in the stomach.
UBT is mainly used for detecting H.pylori, but since there are other bacteria that has urease activity, such as Proteus mirabilis, Citrobacter freundii, Klebsiella pneumoniae, Enterobacter cloacae and Staphylococcus aureus). However, the end point of urease activity is producing ammonia, a toxic substance for the stomach. Therefore, UBT may have potential usage and become a non-invasive alternative diagnostic modality to detect urease-related gastritis.
Indonesia is a multi-ethnic country with over 267 million people living in more than seventeen thousand islands with regional disparities in health service quality. Dyspepsia and gastritis are included in the top 10 diseases and is common in inpatients and outpatients clinics of Indonesia. However, the number of endoscopy experts in Indonesia is lacking and the number of endoscopy centers is still low. Recently, C-UBT, a non-invasive method with simple, less expensive, accurate and easy handling is massively used in clinical practice.
Based on the description above, researchers from the Department of Internal Medicine, Faculty of Medicine, RSUD Dr. Soetomo, Universitas Airlangga succeeded in publishing research results in one of the leading international journals, Acta Medica Indonesiana, This study aimed to determine relationship between urease levels with the severity of gastritis in dyspeptic patients.
Some of the conclusions achieved from the results showed that UBT has a sufficient potential for predicting acute and chronic antral gastritis with a good value of sensitivity. As for other gastritis parameters, UBT showed not a good choice for predicting those stages. The UBT mainly used for determining H. pylori infection; therefore, the involvement of H. pylori infection in the development of gastritis still need to be carefully considered.
Author: Muhammad Miftahussurur
Details of this research can be viewed on this linked article:
http://www.actamedindones.org/index.php/ijim/article/view/1927/pdf
