From the Guidelines
To prepare for a urea breath test, patients should fast for at least 6 hours before the test and stop taking proton pump inhibitors (PPIs) for at least 2 weeks, as well as withhold antibiotics and bismuth for at least 4 weeks prior to the test. The urea breath test (UBT) is a sensitive and specific test for detecting active H. pylori infection, with a sensitivity and specificity of more than 90% 1. However, certain medications can interfere with the accuracy of the test. PPIs, in particular, can decrease the bacterial load in the stomach, leading to false-negative results 1. Stopping PPIs for at least 2 weeks before testing allows the bacteria to repopulate the stomach, making the test more accurate.
- Patients should also avoid taking antibiotics and bismuth-containing medications for at least 4 weeks before the test, as these can also affect the accuracy of the results 1.
- On the day of the test, patients should avoid smoking and physical exertion.
- The test itself involves drinking an oral preparation containing labeled urea, which is then metabolized by H. pylori bacteria in the stomach, releasing labeled carbon dioxide that is measured in the breath.
- Proper preparation is essential to ensure accurate results and prevent false-negative tests, which can lead to delayed or inappropriate treatment. The most recent and highest quality study recommends stopping PPIs for at least 2 weeks before testing 1.
From the Research
Preparation for Urea Breath Test
To prepare for a urea breath test, patients should be aware of the following:
- The test may be affected by proton pump inhibitors (PPIs), which can lead to false negative results 2, 3, 4, 5.
- Patients taking PPIs may need to stop taking them for a certain period before the test, depending on the type of PPI and the test meal used 2, 3.
- The use of antacids instead of PPIs may not impair the sensitivity of the breath test or the stool test 5.
- Even with high-dose PPI treatment, a urea breath test can be performed after peptic ulcer bleeding ceases and results in an acceptable positivity rate 6.
Factors Affecting Test Results
Several factors can affect the results of the urea breath test, including:
- Type of PPI used: different PPIs can have varying effects on the test results 2, 4.
- Test meal: the type of test meal used can influence the accuracy of the test 2, 4.
- Timing of the test: the time from bleeding to testing and from admission to testing may not significantly affect the accuracy of the test 6.
- Dose of PPI: high-dose PPI treatment may not significantly affect the positivity rate of the test 6.
Recommendations
Based on the available evidence, patients preparing for a urea breath test should:
- Inform their doctor about any PPIs they are taking and follow their instructions for stopping or continuing the medication 2, 3, 4, 5.
- Avoid taking PPIs for a certain period before the test, if possible 2, 3.
- Consider using antacids instead of PPIs, if recommended by their doctor 5.
- Follow the instructions provided by their doctor or the testing facility to ensure accurate test results.