How to Order H. pylori Urea Breath Test or Stool Antigen
Yes, both the urea breath test (UBT) and H. pylori stool antigen (HpSA) test are ordered through your laboratory or reference laboratory, just like any other lab test. These are the two preferred non-invasive tests for diagnosing active H. pylori infection 1, 2.
Practical Ordering Information
Urea Breath Test (UBT)
- Order as: "13C-Urea Breath Test for H. pylori" or "14C-Urea Breath Test for H. pylori"
- Availability: The 13C-UBT is now available from major commercial laboratories in the United States, though it may be sent out as a reference test 2
- Superior accuracy: 13C-UBT demonstrates higher specificity (96.93%) compared to 14C-UBT (89.84%) and is the preferred version 3
- Patient preparation required: Must be off antibiotics, bismuth, and proton pump inhibitors (PPIs) for at least 2 weeks before testing to avoid false negatives 2
Stool Antigen Test (HpSA)
- Order as: "H. pylori Stool Antigen Test"
- More accessible: Generally more readily available, cheaper, and faster than UBT 4
- Patient provides: Stool sample to laboratory
- Same preparation: Also requires 2-week cessation of antibiotics, bismuth, and PPIs 2
Key Clinical Considerations
Both tests detect active infection only - they do not remain positive after successful eradication, making them ideal for both initial diagnosis and post-treatment confirmation 2.
Important Pitfalls to Avoid
False negatives occur when patients are on PPIs, antibiotics, or bismuth products because these temporarily reduce bacterial load 2. However, false positives do not occur - so a positive result can be trusted even if the patient didn't stop these medications 2.
H2-receptor antagonists do not affect results and can be substituted for PPIs during the 2-week washout period 2.
If you suspect a false negative, repeat the test after an appropriate interval (at least 2 weeks off interfering medications) 2.
Which Test to Choose
The UBT is considered the gold standard non-invasive test with sensitivity of 96.60% and specificity of 96.93% for the 13C version 3. However, the stool antigen test is a viable alternative with comparable accuracy (sensitivity 95.4%, specificity 83.4-95.5%) and offers practical advantages 5, 4:
- More affordable
- Faster turnaround
- Better patient tolerance
- No special equipment needed at point of care
For post-treatment confirmation of eradication, UBT is preferred, with stool antigen as the alternative if UBT is unavailable 6.
Insurance and Reimbursement
Note that serology (IgG antibody tests) is generally not reimbursed by Medicare and should be avoided for routine diagnosis, as it cannot distinguish active infection from past exposure 2. Only FDA-approved tests should be requested from commercial laboratories 2.