13C-urea Breath Test (Helicobacter Pylori Detection)

The 13C-urea breath test is used for direct detection of the bacterium Helicobacter pylori, which is a gram-negative, microaerophilic rod-shaped bacterium that can colonize the human stomach. Helicobacer pylori infection leads to chronic gastritis/stomach inflammation (type B; bacterial gastritis), which in turn is a risk factor for gastroduodenal ulcer disease (gastric and duodenal ulcers) and malignancies of the stomach (gastric carcinoma and MALT lymphoma). The prevalence (disease frequency) of Helicobacter pylori infection is about 50% worldwide; in Germany, about 35%. The following upper abdominal symptoms may indicate Helicobacter pylori infection:

Furthermore, may indicate a Helicobacter pylori infection:

The procedure

The test is based on the fact that the Helicobacter pylori bacterium has a special enzyme, urease, which allows it to break down urea into carbon dioxide (CO2) and ammonia (NH3). The patient is given 13C-urea orally. If the gastric mucosa is colonized with Helicobacter, the labeled urea is rapidly cleaved and the CO2 enters the lungs with the blood and can eventually be detected in the breath. Without the presence of Helicobacter pylori, the urea is excreted unchanged in the urine. Compared to the other three Helicobacter direct detections – rapid urease test, histology (gold standard) and culture – which require gastroscopy (gastroscopy) with biopsy (tissue sample), the 13C-urea breath test is a non-invasive method, but its reliability is in no way inferior to the other three testing methods. The test has demonstrated high test performance in clinical studies with a sensitivity (percentage of diseased patients in whom the disease is detected by the use of the method, i.e. a positive result occurs) of 99% and specificity (probability that actually healthy persons who do not suffer from the disease in question are also detected as healthy in the test) of 100%. The 13C-urea breath test is therefore well suited both as an initial diagnostic test and with regard to follow-up, and can also be used in children.

Indications (areas of application)

  • Diagnosis of Helicobacter infection in patients with ventricular ulcer (gastric ulcer).
  • Z. n. Eradication therapy (after complete elimination of the bacterium) – no earlier than 4 weeks after therapy.
  • Exclusion of reinfection in gastroscopically confirmed duodenal ulcer (duodenal ulcer).
  • Avoidance of gastroscopy (gastroscopy) in children with suspected ventricular ulcer.
  • Avoidance of gastroscopy in individuals who cannot undergo gastroscopy (contraindications/counterindications) or do not want to undergo gastroscopy.
  • Serologically positive patients (detection by blood test), differential diagnosis between old, persistent antibody titer or reinfection (re-infection).
  • Non-conclusive diagnosis under consideration of gastroscopy and / or serology before planned therapy.

Assessment

Delta value Rating
< 4,0 ‰ No evidence of Helicobacter infection
4,0-5,0 ‰ Borderline finding, control recommended
> 5,0 ‰ Indication of a florid Helicobacter infection requiring therapy.

Benefit

The 13C-urea breath test is not burdensome for you and can help prevent stomach ulcers and cancers of the stomach. If the Helicobacter pylori bacterium is detected, you may be successfully treated with a combination therapy of various antibiotics and a proton pump inhibitor (such as omeprazole). In this context, additional micronutrient therapy with probiotics can support the eradication – that is, the elimination – of Helicobacter pylori. If you have been diagnosed with the bacterium, you should watch your meat consumption.The EPIC study (European Investigation into Cancer and Nutrition) showed that patients with Helicobacter pylori infection and a daily average meat consumption of 100 g had a 5-fold increased risk of gastric cancer. Poultry meat had no effect on risk. The breath test is an important screening test for you and helps maintain your health.