OBJECTIVE To compare the sensitivity and specificity of C[14] urea breath test with histopathological findings in biopsies obtained through endoscopy. METHODS In this cross-sectional study, conducted at the Medical Faculty Ankara University, Ankara, Turkey between January and October 2009, 100 patients aged 65 and above who fulfilled the criteria for inclusion were enrolled. Oesophago-gastroduodenoscopy was carried out on the patients after eight hours of fasting, using a Fujinon endoscope, by the same expert. C14 urea breath tests were carried out on all patients with a capsule containing 37 kBq(1micro Ci) C14 urea/citric acid. Evaluation of all data was carried out using SPSS 11.5. Categorical variables were compared through Pearson Chi squared or Fisher's exact test. P < 0.005 was taken as statistically significant. RESULTS The average age of the patients was 71 +/- 5 years; 43 (43%) were male; and 57 (57%) were female. Helicobacter pylori positivity was found to be 35 (35%) in histopathological evaluation, and 36 (36%) in the C14 urea breath test. Of the 35 patients, 32 (91.4%) were found to be positive by the C14 urea breath test also. Of the 65 patients who were found to be negative on histopathology, 61 (93.8%) were also found to be Hp negative by the C14 urea breath test, and 4 (6.2%) were evaluated as false positive. A statistically significant correlation (p < 0.001) was found between histopathological and C14 urea breath test results. Compared with histopathology, the sensitivity of the urea breath test was 91.4%, and its specificity was 93.8%. A statistically significant (p < 0.001) relationship was found between histopathological results and the results of the C14 urea breath test. CONCLUSIONS The sensitivity and specificity of the C[14] urea breath test in the group of elderly patients selected was high. The C14 urea breath test can be considered in the elderly group for diagnosis of Helicobacter pylori infection.