2 Nakhaei

JRHS 2010; 10(2): 77-80

Copyright © Journal of Research in Health Sciences        

Prevalence of Helicobacter Pylori Infection in Patients with Digestive Complaints Using Urea Breath Test in Mashhad, Northeast Iran

Mahboobeh Nakhaei Moghaddam (PhD)*

Department of Biology, Faculty of Sciences, Islamic Azad University- Mashhad Branch

Correspondence:Mahboobeh Nakhaei Moghaddam (PhD), E-mail 1:  m.nakhaei@mshdiau.ac.ir

Received: 28 September 2010, Revised: 26 October 2010, Accepted: 27 November 2010, Available online: 30 November 2010


Background: Helicobacter pylori infection is the most common gastrointestinal bacterial disease worldwide. Although using culture is considered as the golden standard method for diagnosis of H. pylori infection, urea breath test is a notable alternative method because it is an easy, quick, and non-invasive approach. The aim of this study was to estimate the prevalence of H. pylori infection in patients with digestive discomforts using urea breath test in Mashhad County, northeast of Iran.

Methods: The study involved 814 patients, 467 women and 347 men, aged 17-80 years, with gastrointestinal symptom from January 2007 to November 2008. The urea breath test was performed and the patients ingested a solution of isotope labeled urea. The expired air was collected and was analyzed using the Heliprobe breath card (Noster System, Stockholm, Sweden).

Results: The results of the test were positive for 698 out of 814 (85.75%) patients including 403 (86.30%) of women and 295 (85.01%) of men. However, the difference between the two groups was not statistically significant. Positive cases were classified by age. The highest prevalence rate of H. pylori infection was observed among 50-60 years old patients.

Conclusions: The infection of H. pylori is very common among patients who have gastric complain and can be easily diagnosed by noninvasive urea breath test. Since H. pylori infection is related to poor prognosis outcomes such as gastric cancer. Therefore, screening and treatment of infected people especially symptomatic cases using urea breath test is a priority. 

Keywords: Helicobacter pylori, Prevalence, Breath test, Iran                


Helicobacter pylori infection is the most common gastrointestinal bacterial disease worldwide which is associated with gastritis, peptic and duodenal ulcers and gastric adenocarcinoma 1.

H. pylori infection is usually detected through endoscopic and histological evaluations using culture or urease tests (invasive tests). However, there is an alternative noninvasive test using labeled carbon urea breath test (no radioactive 13C-UBT and radioactive 14C-UBT) and serological examinations 2. All biopsy-based methods are liable sampling error due to some reasons. Up to 14% of patients with H. pylori will not have antral infection but will have H. pylori elsewhere in the stomach, especially if there is gastric atrophy, intestinal metaplasia or bile reflux. In addition, after partially effective eradication therapy low levels of recurrent infection can be easily missed by biopsy. For these reasons, taking multiple biopsies from the antrum and corpus for histological evaluation and as well as culture or urease testing is recommended 3, 4.

Urea breath test (UBT) is a rapid diagnostic procedure used to identify H. pylori infections. This organism produces a powerful urease, which provides the basis for its detection in this test 5. The sensitivity and specificity of the test were estimated 97% and 95%, respectively 6, 7. In urea breath test, labeled carbon dioxide in exhaled breath is collected and measured by different instrumentation. Isotope labeled carbon dioxide shows that the urea has been split. The hydrolyzed labeled urea indicates the presence of H. pylori bacteria in the stomach.

As there was no accurate information about the prevalence of H. pylori infection in Mashhad, this study was conducted on patients with digestive discomfort referred to a clinic in Mashhad to determine the prevalence of H. pylori infection using non- invasive urea breath test.

Materials and Methods

In this cross-sectional study, 814 patients aged 1780 years whose chief complain was digestive discomfort (stomachache, flatulence, heartburn, reflux and epigastric pain) were examined for H. pylori infection from January 2007 to November 2008. In this research, 347 male and 467 female patients who referred to Hamun Clinic in Mashhad Country, the north east of Iran, were tested.

Diagnostic experiments were performed by Heliprobe 14C-UBT (Noster System, Stockholm, Sweden). Heliprobe 1 micro Curie 14C was given to the patients as either a capsule or solution in water. After 10-15 min, the patients were asked to blow into the Helicoprobe breathcard. A color change in breath cards indicated that a sufficient volume of CO2 was collected. Then breath cards were analyzed by the Heliprobe analyzer (b-scintillation counter). Infection status was determined by the number of detected 14C counts per measurement (CPM). The results were categorized in three grades including grade 0 (CPM25), grade 1 (CPM 25-50) and grade 2 (CPM 50). Grade 0 was considered as negative (uninfected by H. pylori), Grade 1 as borderline, and Grade 2 as positive (infected by H. pylori).

Statistical analysis of the results was carried out using SPSS version 15 software. Chi-square test was used for subgroup analysis. The p<0.05 was considered statistically significant.


The result of urea breath test was positive for 698 out of 814 (85.75%) patients. Accordingly, the prevalence of H. pylori infection was 86.30% in women (403/467) and 85.01% in men (295/347). There was no statistically significant difference between the two groups. Table 1 shows the results of urea breath test for diagnosis of H. pylori by sex and age. According to these findings, the prevalence rate of H. pylori infection was highest among 50-60 years old patients. The prevalence rate of infection was highest in men aged 40-50 years and in women aged 50-60 years. The prevalence of H. pylori infection was nearly the same among all age groups


Since H. pylori is related to many poor prognostic outcomes such as gastritis, peptic ulcer, and stomach adenocarcinoma, the diagnosis and treatment of infected people especially symptomatic cases should be the focus of special attention. The 14C-UBT is widely used for diagnosis of gastric H. pylori infection. This method is simple, easy to repeat, reliable, non-invasive, and economic 8. UBT is a highly sensitive and specific test compared to invasive methods used for H. pylori diagnosis. The sensitivity and specificity of 14C-UBT were estimated 98% and 91% by Rasool and et al. 9. This test is widely used to screen patients before endoscopy and to assess the success of therapies aimed at eradicating H. pylori 10-12. In addition, this test could be very important diagnostic tool in the high H. pylori prevalence areas 12 and less developed countries 9. Since the biological half-life of urea is short, the cumulated radiation does from each breath test is small and far below radiation in natural radiation 12.

Gomollon et al. reported the prevalence of H. pylori infection 72% in Spain. According to this study, the UBT test was much more sensitive (97%) and specific (100%) than other conventional tests including enzyme immuno assay (EIA), rapid urease test, histology and culture 13. UBT was positive in 27.4% of school students with abdominal pain in Makkah, Saudi Arabia 14. 17.7% of children infected with HIV-1 were positive H. pylori infection based on serology findings, whereas 20% of them were positive using 13C-UBT 15.

Table 1: The results of urea breath test for diagnosis of H. pylori infection among the patients with digestive complaint by age and sex

Age groups

               Proportion of H. Pylori infection (%)





22/28 (78.6)

10/13 (76.9)

32/41 (78.0)


69/88 (78.4)

67/79 (84.8)

136/167 (81.4)


114/126 (90.5)

102/119 (85.7)



104/114 (91.2)

60/69 (87.0)

164/183 (89.6)


51/55 (92.7)

24/28 (85.7)

75/83 (90.4)


21/27 (77.8)

17/21 (81.0)

38/48 (79.2)


10/14 (71.4)

7/9 (77.8)

17/23 (73.9)

Unknown a

12/15 (80.0)

8/9 (88.9)

20/24 (83.3)


403/467 (86.3)

295/347 (85.0)

698/814 (85.7)

a The age of 24 patents (15 women and 9 men) was unknown.

Logan and colleagues reported that bacterial culture of H. pylori was not a sensitive approach. However, this conclusion may be partly due to sampling error and technical difficulties associated with culture 5

“A previous study conducted in Mashhad estimated the prevalence rate of H. pylori infection 62.56% in patients with digestive complaints using direct stain, urease and culture method” 16 while the present study estimated the prevalence of H. pylori infection much more (87.75%) in the similar population using 14C-UBT. The 13C-UBT and 14C-UBT are now considered as the gold standard techniques for the detection of H. pylori infection 17. Pathak et al. evaluated the efficacy and safety of 14C-UBT for the detection of H. pylori infection in children without any fear of radiation phobia where 13C-UBT was unavailable 17.


The H. pylori infection is considerably common among patients who have gastric complain and is easily diagnosed by noninvasive urea breath test. On the other hand, H. pylori infection is related to many poor prognosis outcomes such as peptic and/or duodenal ulcer as well as gastric cancer. Therefore, screening and treatment of infected people especially symptomatic cases using urea breath is a priority.   


The author wishes to thank Dr Mahdi Nakhaei Moghaddam who conducted the urea breath test.

Ethical Approval

This research was conducted in accordance with ethical principles on clinical specimens and all patients filled out an informed consent.

Conflict of interest statement

The author declares that she has no conflicts of interest.


This study was funded by Hamun Clinic affiliated the Islamic Azad University. 


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