Helicobacter pylori Urea Breath Test (Delta Count)
Other marker
H. pylori Breath Test
Helicobacter pylori Urea Breath Test (Delta Count)
A non-invasive test for active Helicobacter pylori stomach infection. After swallowing urea labelled with carbon-13, the test measures the change in labelled carbon dioxide in the breath (the 'delta' value); H. pylori splits urea and releases the labelled CO2, so a high delta indicates active infection. It is the preferred non-endoscopic test for both diagnosis and confirmation of eradication.
PED Notes
Worth knowing about for athletes with reflux, dyspepsia, or ulcer symptoms, which can be aggravated by heavy NSAID use (common for training aches) and by the gastric stress of very high food volumes. Two practical points: recent proton pump inhibitors, antibiotics, or bismuth can suppress the bacteria and cause a false-negative, so PPIs should be stopped roughly 2 weeks and antibiotics 4 weeks before testing; and the same test is used 4+ weeks after treatment to confirm the infection is cleared.
When high
When positive (>5.0 delta counts):
- Indicates active H. pylori infection. Standard treatment is eradication therapy: a proton pump inhibitor combined with two antibiotics (for example amoxicillin plus clarithromycin) for 14 days, or bismuth quadruple therapy where resistance is a concern; prescribed and supervised by a physician
- Confirm eradication with a repeat urea breath test at least 4 weeks after finishing antibiotics and off PPIs for 2 weeks
- Reduce gastric irritants meanwhile: minimise NSAIDs (which compound ulcer risk), alcohol, and smoking
- Adjuncts (supportive, not a substitute for eradication): certain probiotics (for example Lactobacillus and Saccharomyces boulardii) can improve eradication tolerability and reduce antibiotic-associated side effects
Borderline (2.5-5.0 delta counts, equivocal):
- Repeat the test, ensuring PPIs, antibiotics, and bismuth have been withheld for the recommended intervals, before deciding on treatment
When low
When negative (<2.5 delta counts):
- No active H. pylori infection detected, provided the test was done correctly (off PPIs for ~2 weeks and antibiotics for ~4 weeks); a false-negative is otherwise possible
- If dyspeptic symptoms persist, consider other causes (NSAID-related gastritis, reflux, functional dyspepsia) and review NSAID use
History Chart
Reading History
Frequently Asked Questions
Reference Ranges
Standard Range