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Urea Breath Test (UBT)

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NYU Langone Hospital – Long Island

Mount Sinai Hospital, New York

Mount Sinai South Nassau

Mercy Medical Center

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What Is the Urea Breath Test (UBT)?

The urea breath test (UBT) is used when Helicobacter pylori (H. pylori) infection is suspected. H. pylori infection is very common. The bacteria, which when present resides in the stomach, are the primary cause of peptic ulcer disease and can also increase the risk of developing gastric cancer. The urea breath test, also known as the H. pylori breath test, is a quick and non-invasive way to determine if the bacteria are present. 

What Is an H. pylori Infection?

It’s estimated that around 30 percent of the world’s population has H. pylori infection, with numbers being higher in some countries. H. pylori attacks the stomach’s mucosal lining, which can cause disease as well as raise your risk factors for serious diseases, such as gastric cancer. The World Health Organization (WHO) has classified H. pylori as a Class 1 carcinogen, which means the bacteria can produce stomach cancer in humans. It also raises your risk of developing a certain type of stomach lymphoma and is the cause of many duodenal and gastric ulcers.

Many people do not know they have an H.pylori infection because they show no signs or symptoms. The infection is easily transmitted, however, researchers are not entirely sure of the mode of transmission. It is suggested that H. pylori are spread through the fecal-oral route and through contaminated food and water. For those who do experience symptoms, the most common ones are:

  • Pain in the upper part of the abdomen
  • Loss of appetite
  • Belching
  • Indigestion
  • Nausea
  • Heartburn
  • Vomiting

H. pylori infection shares many common symptoms with other gastrointestinal disorders, so if you’re experiencing GI symptoms, let your physician know. One of the most common ways to check for the presence of H. pylori is through the urea breath test. 

How Do I Prepare for the Urea Breath Test (UBT)?

While the test is simple and quick, there is some preparation involved to ensure the accuracy of the test. Prior to the procedure, you’ll have a consultation with your gastroenterologist or physician to discuss your medical history. Let your doctor know if you have phenylketonuria (high levels of phenylalanine in the blood) or if you are allergic to any medications. 

Four weeks before your test, do not take any Pepto-Bismol or antibiotics. Two weeks before the test, you are asked to pause taking any over-the-counter proton pump inhibitors (PPIs). These include omeprazole and pantoprazole, among others. One hour before the test, you are asked not to smoke, eat, or drink (including water). 

How Is the Urea Breath Test (UBT) performed?

You will swallow a capsule that contains urea along with a sip of water. After a few minutes, the lab technician will ask you to breathe into a bag. That breath sample is then sent to the laboratory to be analyzed. 

If H. pylori are present, it converts urea into carbon dioxide, which is absorbed into the blood through the stomach lining. Through the bloodstream, urea travels to the lungs, and elevated amounts of carbon dioxide are present as you exhale. UBT tests for that elevated carbon dioxide level, which will be in the breath sample. 

What Happens After the Urea Breath Test (UBT)?

After the procedure, you can eat and drink normally and resume regular activities unless otherwise instructed by your doctor. Occasionally, some patients may feel side effects from swallowing the capsule. These can include:

  • Abdominal pain
  • Nausea
  • Vomiting
  • Fatigue

Typically, these side effects fade independently and don’t require any medical intervention. 

After the laboratory has analyzed your sample, your doctor will inform you of the results.

How Do You Treat H. pylori Infection?

If H. pylori infection is found, avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. These increase the risk of developing gastric ulcers.

H. pylori is typically treated with a combination of antibiotics and PPIs. Amoxicillin and clarithromycin are commonly prescribed. Another regimen involves taking bismuth subsalicylate with metronidazole, tetracycline and a PPI.

PPIs used in the treatment of H. pylori include omeprazole, pantoprazole, and other similar PPIs. Your doctor may advise you to take Pepto-Bismol during your course of treatment, as it protects the stomach lining. The course of antibiotics and PPIs is usually 10 to 14 days. Four weeks after completing the combination treatment, your physician will take a stool sample or repeat the UBT to ensure that H. pylori are no longer present. 

Can H. pylori Infection Be Prevented?

You can lower your risk of developing H.pylori by using clean water for drinking and preparing food, particularly in areas where the water supply may be contaminated. Also, wash your hands thoroughly after using the bathroom. Because H. pylori are thought to travel the fecal-oral route, infection can happen very easily when an infected person does not wash their hands and spreads the bacteria.