Understanding the Urea Helicobacter pylori Breath Test

Helicobacter pylori is a type of bacteria that can cause various gastric diseases, including peptic ulcers and chronic atrophic gastritis. However, these bacteria are not what we once thought they were. They are more devious than most microbes and can burrow into the lining of the stomach and secrete urease, which kills acid-producing cells. This process decreases stomach acid, raising the pH from the normal 2-4 to a more neutral pH of 5-7. With the pH more alkaline, H. pylori can change their behavior and start secreting Lewis antibodies, which makes them invisible to the immune system. This process, called molecular mimicry, causes confusion with H. pylori antibody testing, making it useless.

As a result, it requires a TH1 response to get rid of bacteria and mold/yeast, and since the immune system can only see the damage being done, it allows food particles to cross the lining, causing a TH2 response to any food being eaten and a TH17 response to clear the damaged tissue. Additionally, microbial antibodies can be negative, while DNA/PCR results report positive, making it more challenging to diagnose the presence of H. pylori.

Lipopolysaccharide (LPS) is an essential component of the gram-negative cell envelope. H. pylori LPS contains Lewis antigenic structures, which allows H. pylori to evade the immune system by mimicking the Lewis antigens expressed on the gastric epithelium. As a result, blood and saliva antibody tests for H. pylori report false-negative results. The only test the H. pylori cannot hide from is the PCR/DNA tests.

Shape-Shifting H. pylori

H. pylori has the ability to shift stomach pH to its preferred alkaline pH. When this pH is reached, H. pylori produces Lewis antibodies, which make them invisible to the immune system while damage is still occurring. This causes blood and saliva antibody tests for H. pylori to report false-negative results. Histology has been proposed to be very sensitive and specific, but the question is how, by simply looking at the morphology of the bacteria in the microscope, one can claim that the bacterium is exclusively H. pylori or Staphylococcus or Streptococcus.

Stressed H. pylori are misdiagnosed as Streptococcus or Staph infection.

Similar to some other microorganisms, H. pylori is able to modify its morphology to survive in many adverse environmental conditions such as antibiotics, temperature, pH, and increased oxygen tension. It can enter a “viable but non-culturable” (VBNC) state, which is an inactive form of life induced by stressful conditions. This state is characterized by a metabolic blackout and a diversion from the classical bacterial spiral shape, which is crucial for gastric colonization and cork-screwing penetration of dense mucus covering the wall of this organ. Thus, the microbe takes on a coccoid appearance while retaining its active virulence factors with minimal metabolic activity. VBNC organisms express their genes at low levels and cannot be grown using conventional culture techniques.

H. pylori Breath Test Reports Urease-Producing Bacteria

The Urea Helicobacter pylori Breath Test is a non-invasive and simple test that detects the presence of urease producing microbes in the stomach. The 13C UBT is believed to be specific, but with present revelation of the fact that mouth, stomach and digestive tract are colonized by many other urease producing bacteria makes it questionable.

This test measures the concentration of carbon dioxide (CO2) in the patient’s breath after the ingestion of a urea solution labeled with a radioactive carbon isotope, 14C or 13C. H. pylori secretes urease, which breaks down urea into carbon dioxide and ammonia. As a result, radioactive carbon dioxide is detected in the breath, indicating the presence of Urease-Producing Bacteria in the stomach. This test is highly accurate, with a sensitivity and specificity of greater than 95% for Urease-Producing Bacteria.

A long-term H. pylori infection will show negative antibodies.

In summary, while the Urease/H. Pylori breath test is a questionable diagnostic tool for H. pylori. This test does not consider the possibility of other Urease producing Bacteria. Adding further to the confusion of diagnosing and treating H. pylori is their ability to become invisible to the immune system / antibodies.

It is more important to integrate PCR/DNA analysis to ensure accurate diagnosis and treatment. Moreover, understanding the digestive chemistry in our gut, the status of your immune response and the relationship between oral dysbiosis and gastrointestinal symptoms can help improve outcomes for patients with SIBO.