Colonization of the stomach with Helicobacter (Campylobacter) pylori is common in patients with duodenal ulcer disease, which is known for its high acid secretion. Although the bacterium is usually isolated by culture of a gastric biopsy specimen, viable organisms may sometimes be found in the acidic gastric juice. It was postulated that urease, by generating ammonia, protected H. pylori from acid. To test this hypothesis, the pH susceptibility of H. pylori, Proteus mirabilis, and the urease-negative Campylobacter jejuni was examined in the presence and absence of urea. It was found that without urea the three bacteria were all highly susceptible to acid. In striking contrast, the addition of 5 mmol/L of urea completely protected H. pylori but not P. mirabilis or C. jejuni from pH values as low as 1.5. Furthermore, the protective effect of urea on H. pylori was found with urea concentrations as low as 0.05 mmol/L. It is concluded that the high urease activity of H. pylori enables it to survive in gastric acid.