Urea Breath Test procedure for Helicobacter pylori: 2024 guide

The urea breath test is one of the diagnostic procedures for Helicobacter pylori. A bacteria that is common in about two-thirds of the worlds population and can survive in the stomach in some people without causing any infection as it is found as normal flora.

However, this bacterium causes various gastrointestinal diseases such as gastritis, peptic ulcers, and in some cases stomach cancer. Symptoms range from epigastric pain, bloating, no appetite, nausea and vomiting to unexplained weight loss and bouts of diarrhea.

 The Urea breath test is non-invasive, simple, accurate, and also fairly affordable. This test is normally done to check for an active H. pylori infection or whether treatment against H. pylori was effective.

Urea Breath test procedure

The Urea breath test takes about 40 minutes and the procedure is as follows:

1. The patient should not eat or drink anything six hours before the test. Also, they should not take antibiotics, proton pump inhibitors, or histamine blockers four weeks before the test. This will ensure the accuracy of the test.
2. The patient is asked to exhale in the balloon sample collection bag and measure the initial Carbon IV oxide level.
3. The patient is then given the urea-labeled solution or tablet, mostly lemon flavored to drink.
4. After 15 to 30 minutes, the patient is asked to exhale into a new balloon collection device
5. The second breath sample is analyzed for the presence of labeled carbon IV oxide using specialized equipment.

Principle of Urea Breath Test for H.pylori

The Urea breath test works on the principle that the urea administered orally, is labeled with isotopes Carbon-13 or carbon-14 that are hydrolyzed by urase enzyme in H.pylori to carbon IV oxide exhaled in one’s breath. If H. pylori is positive, the urase enzyme will metabolize the urea releasing labeled carbon IV oxide that is expired in breath that will be then analyzed for presence or increase in carbon IV oxide using specialized equipment.

Result Interpretation

Negative result: No significant increase in or absence of labeled carbon IV oxide. This shows that the urase enzyme did not break down the urea

Positive result: Significant increase in or presence of labeled carbon IV oxide. This means that the urase enzyme hydrolyzed the urea ingested.

If the test is positive, your doctor can recommend an endoscopy, biopsy or other effective treatments that will help lower the acidity levels in your stomach

Apart from the urea breath test there are other ways to diagnose H. pylori such as:

• Stool tests: this can be done in three ways.
• Antigen tests– these are most commonly available and used.  They detect h.pylori antigens in stool
• PCR (polymerase chain reaction) tests– they detect mutations in the bacteria that can make it resistant to antibiotics. These tests are quite expensive than antigen tests and may not be easily available in most places.
• Culture and sensitivity– these involve isolating h.pylori colonies in stool and checking for  its resistance to different antibiotics. This method is effective as it also guides your doctor on the right antibiotics that fight the bacteria to administer.
• Endoscopy: This method involves inserting a camera down the upper gastrointestinal part of the body to check for inflammation and extent of the ulcers and sometimes collect samples for more tests. This test may require anesthesia
• X-ray: the doctor will administer barium orally to coat your throat and stomach to make it appear clear white in the x-ray. The non-white parts pin point ulcers.
• CT (computed tomography) scan: used in the diagnosis of peptic ulcers
• Blood tests: The tests look for antibodies that play a role in the effectiveness of one’s immune system in fighting H.pylori

Treatment of H.pylori

H.pylori induced ulcers can be treated using locally available medicines. These include:

• Proton pump inhibitors (PPIs): an example is omeprazole or esomeprazole. They work by blocking the glands that produce acid in the stomach.
• Histamine-2 blockers: their mode of action is to block histamine that encourages the stomach to produce acid.an example of such is cimetidine
• Antibiotics such as amoxicillin, tinidazole, metronidazole are commonly used in the treatment of h.pylori induced ulcers
• Tripple therapy: this is the combined use of PPIs and antibiotics in the treatment of ulcers. Commonly used therapies are those of amoxicillin, rifabutin and omeprazole or that of amoxicillin, metronidazole and omeprazole.

The parting shot

The Urea breath test for Helicobacter pylori checks for overproduction of h.pylori in the gastrointestinal system by using the hydrolyzation of urea by urase enzyme to produce labeled carbon IV oxide that is collected in a balloon and measured.

If the test is positive, your doctor can recommend more tests for definitive and extensive diagnosis as well as offer appropriate treatment.