title: Natural18O and13C-urea in gastric juice: a new route for non-invasive detection of ulcers.
abstract: The13C-urea breath test (13C-UBT), developed a few decades ago, is widely used as a non-invasive diagnostic method to detect only the presence of the gastric pathogen Helicobacter pylori infection; however, the actual disease state, i.e. whether the person harbouring H. pylori has peptic ulcer disease (PUD) or non-ulcerous dyspepsia (NUD), is still poorly understood. Nevertheless, the present13C-UBT has numerous limitations, drawbacks and pitfalls owing to the ingestion of13C-labelled external urea. Here, we show that H. pylori is able to utilize the natural13C and18O-urea inherently present in the gastric juice in humans for its urease activity which has never been explored before. In vitro measurements of isotopic fractionations of gastric juice urea provide new insights into the actual state of the infection of PUD or NUD. We also provide evidence of the unusual13C and18O-isotopic fractionations of breath CO2that are distinctively altered in individuals with PUD encompassing both gastric and duodenal ulcers as well as with NUD by the enzymatic activity of H. pylori in the gastric niche without oral administration of any13C-enriched external urea. This deepens our understanding of the UBT exploiting the natural13C and18O-gastric juice urea in the pathogenesis of H. pylori infection, reveals the actual disease state of PUD or NUD and thus offers novel opportunities for a simple, robust, cost-effective and non-toxic global strategy devoid of any13C-enriched urea for treating these common diseases by a single breath test. Graphical Abstract Urea breath test without any external urea.
authors.affiliation: Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, West Bengal, 700098, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Maity
authors.affiliation: Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, West Bengal, 700098, India.
authors.forename: Mithun
authors.initials: M
authors.lastname: Pal
authors.affiliation: Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, West Bengal, 700098, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Som
authors.affiliation: Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, West Bengal, 700098, India.
authors.forename: Sanchi
authors.initials: S
authors.lastname: Maithani
authors.affiliation: Department of Gastroenterology, AMRI Hospital, Salt Lake City, JC-16 & 17, Kolkata, West Bengal, 700098, India.
authors.forename: Sujit
authors.initials: S
authors.lastname: Chaudhuri
authors.affiliation: Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, West Bengal, 700098, India. manik.pradhan@bose.res.in.|Technical Research Centre (TRC), S. N. Bose National Centre for Basic Sciences, Salt Lake, JD Block, Sector III, Kolkata, West Bengal, 700098, India. manik.pradhan@bose.res.in.
authors.forename: Manik
authors.initials: M
authors.lastname: Pradhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001944:Breath Tests; D002247:Carbon Isotopes / Q000032:analysis; D004415:Dyspepsia / Q000175:diagnosis*; D005260:Female; D005750:Gastric Juice / Q000737:chemistry*; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010103:Oxygen Isotopes / Q000032:analysis; D010437:Peptic Ulcer / Q000175:diagnosis*; D014508:Urea / Q000032:analysis*; D055815:Young Adult
chemical_list: D002247:Carbon Isotopes; D010103:Oxygen Isotopes; D014508:Urea
keywords: Breath analysis; Gastric juice; Helicobacter pylori; Non-invasive diagnosis; Ulcer; Urea breath test