The C-13 urea breath test in the diagnosis of Helicobacter pylori infection

The urea breath test (UBT) is one of the most important non-invasive method s for detecting Helicobacter pylori infection. The test exploits the hydrol ysis of orally administered urea by the enzyme urease, which H pylori produ ces in large quantities. Urea is hydrolysed to ammonia and carbon dioxide, which diffuses into the blood and is excreted by the lungs. Isotopically la belled CO2 can be detected in breath using various methods. Labelling urea with C-13 is becoming increasingly popular because this non- radioactive isotope is innocuous and can be safely used in children and wom en of childbearing age. Breath samples can also be sent by post or courier to remote analysis centres. The test is easy to perform and can be repeated as often as required in the same patient. A meal must be given to increase the contact time between the tracer and the H pylori urease inside the sto mach. The test has been simplified to the point that two breath samples col lected before and 30 minutes after the ingestion of urea in a liquid form s uffice to provide reliable diagnostic information. The cost of producing C- 13-urea is high, but it may be possible to reduce the dosage further by adm inistering it in capsule form. An isotope ratio mass spectrometer (IRMS) is generally used to measure LSC enrichment in breath samples, but this machine is expensive. In order to re duce this cost, new and cheaper equipment based on non-dispersive, isotope selective, infrared spectroscopy (NDIRS) and laser assisted ratio analysis (LARA) have recently been developed. These are valid alternatives to IRMS a lthough they cannot process the same large number of breath samples simulta neously. These promising advances will certainly promote the wider use of the C-13-U BT, which is especially useful for epidemiological studies in children and adults, for screening patients before endoscopy, and for assessing the effi cacy of eradication regimens.