There are many ways to test for H. pylori infection, invasive tests and noninvasive tests. The most effective noninvasive test is called the urease breath test. Urea is a waste product humans make and excrete in the urine. Humans cannot digest or metabolize urea. H. pylori bacteria metabolize and use urea. Many of the tests for H. pylori are based on urea metabolism. In a urease breath test, you drink a small amount of very mildly radioactive urea, and then in a few minutes your breath is collected in a bag and analyzed. Normally, you breathe in oxygen and breathe out carbon dioxide. If radioactive carbon dioxide is present in the bag, then H. pylori is present and has digested the radioactive urea. This test is useful because it detects active infection.
There are also blood tests for H. pylori. Blood tests detect the presence of H. pylori antibodies in the blood. An antibody is a protein your body produces when you are exposed to a foreign substance, such as an infection. The problem with this test is when you've had a prior H. pylori infection that is gone, the test remains positive. Stool tests are also available to check for H. pylori.
Invasive tests are done at the time of an endoscopy. The stomach can be biopsied and checked for H. pylori infection. The tissue can be stained with special chemicals and examined under the microscope by a pathologist to look for the actual bacteria. Or a CLO test can be done, which is when a stomach biopsy is done and the tissue is placed in a tiny well containing a gel with urea in it. If H. pylori bacteria are present, they will metabolize the urea and the well will change color. These tests are very useful because they diagnose an active infection and not a previous one.
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