Review article: 13C‐urea breath test in the diagnosis of Helicobacter pylori infection – a critical review

Summary The urea breath test is a non‐invasive, simple and safe test which provides excellent accuracy both for the initial diagnosis of Helicobacter pylori infection and for the confirmation of its eradication after treatment. Some studies have found no differences between urea breath test performed under non‐fasting conditions. The simplicity, good tolerance and economy of the citric acid test meal probably make its systematic use advisable. The urea breath test protocol may be performed with relatively low doses (<100 mg) of urea: 75 mg or even 50 mg seem to be sufficient. With the most widely used protocol (with citric acid and 75 mg of urea), excellent accuracy is obtained when breath samples are collected as early as 10–15 min after urea ingestion. A unique and generally proposed cut‐off level is not possible because it has to be adapted to different factors, such as the test meal, the dose and type of urea, or the pre‐/post‐treatment setting. Fortunately, because positive and negative urea breath test results tend to cluster outside of the range between 2 and 5‰, a change in cut‐off value within this range would be expected to have little effect on clinical accuracy of the test.