Breath tests in Helicobacter pylori infection: methodological aspects

Abstract

The urea breath test (*C-UBT) is generally considered as a simple, non-invasive and accurate test to demonstrate Helicobacter pylori (Hp) infection. Sensitivity and specificity vary between 95-100%. Some authors even claim that this test should be considered 'gold standard' for the detection of active Hp infection. Although today many centres already use this test in clinical praxis, there exists no uniformity in test protocol. Most modifications recently published in literature, had only minor impact on the accuracy of the test. More important than 'inventing' the n'th *C-UBT, there is a need for a consensus on features such as: which isotope, is a test meal necessary and which one should be used, what is the appropriate urea dose, how many breath samples should be taken and at what time interval, is there a difference between children and adults, what is the most appropriate method to differentiate between buccal and stomach urease activity. Even the expression of the cut-off value has to be defined. Ideally, the answers should result in one *C-UBT which can be used in research and clinical practice. In conclusion, *C-UBT is a simple, non-invasive and accurate test to demonstrate H. pylori infection. To make results comparable there is an absolute need for standardisation in methodology.