The (13)C-urea breath test for non-invasive diagnosis of Helicobacter pylori infection: which procedure and which measuring equipment?

1) The (13)C-urea breath test is one of the most important non-invasive methods for detecting Helicobacter pylori infection in both pre- and post-treatment phases. 2) In order to render the test less expensive and more rapid, a series of modifications have recently been proposed concerning the dose of (13)C-urea and its formulation, as well as the type of measuring equipment used for detecting (13)CO(2) in breath samples. 3) The use of small doses (40--50 mg) of isotope in gelatin capsules or mixed with citric acid in rapid-releasing tablets seems to be promising as it shortens sampling time to 10--20 min. 4) Infrared spectroscopy and laser-assisted ratio analysis equipment are two new valid and less expensive alternatives to conventional isotope mass spectrometry for (13)C analysis in breath. The (13)C-urea breath test is one of the most accurate non-invasive tests for diagnosing Helicobacter pylori infection. This method has become increasingly popular in the last decade since it employs an innocuous, non-radioactive isotope that can be safely used in both children and adults. The test has been recently simplified by reducing the dose of (13)C-urea used, by adopting shorter sampling times and by using new and cheaper measuring methods for (13)C analysis in the breath samples. These include nondispersive isotope-selective infrared spectroscopy (NDIRS) and laser-assisted ratio analysis (LARA), which greatly differ from each other in their technical characteristics and cost. Both NDIRS and LARA are valid alternatives to conventional isotope ratio mass spectrometry (IRMS), although LARA appears to be more suitable for large laboratories or gastroenterological centres, which need to process many breath samples per day, whereas NDIRS seems to be more suitable for small laboratories or doctors' offices.