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Accurate Diagnosis ofHelicobacter pylori:Urease Tests

Gastroenterology Clinics of North America
Publication Date
DOI: 10.1016/s0889-8553(05)70154-0
  • Biology
  • Medicine


The presence of urease in the gastric mucosa of humans and animals was reported in the scientific literature in 1924 by Luck and Seth. 21 Those investigators assumed that the enzyme was part of the normal gastric mucosal epithelium because it was almost universally present in the animals they examined. This assumption was perpetuated in human studies, particularly by Fitzgerald and Murphy in 1950. 8 Hints that urease was secondary to bacterial infection of the mucosa came from an article by Lieber and Lefevre in 1959, 19 in which they observed that in humans, treatment with tetracycline could eliminate most of the gastric urease activity. Subsequent observations in gnotobiotic animals confirmed that normal gastric mucosa (bacteria-free) did not produce gastric urease. 4 Most of these observations were outside the mainstream of the gastroenterologic literature and were not followed up once the fiberoptic endoscope became available in the 1970s. With the observation that Helicobacter pylori was a strong urease producer, 16 several groups 11,12,24,25 began work on the use of urease as a marker for H. pylori in the human stomach. This work ultimately resulted in the rapid urease test and the urea breath test, both now widely used in the diagnosis of this common infection. 10,23

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