Will Carafate Affect a Urea Breath Test for H. Pylori?
No, sucralfate (Carafate) does not need to be stopped before a urea breath test for H. pylori, as it does not cause false-negative results and is not listed among medications that interfere with test accuracy.
Medications That DO Require Discontinuation
The major guidelines systematically identify only three classes of medications that interfere with urea breath test accuracy 1, 2:
- Proton pump inhibitors (PPIs): Stop for at least 2 weeks before testing, as they cause 10-40% false-negative rates by reducing bacterial load 1, 2
- Antibiotics: Discontinue for at least 4 weeks prior to testing, as they temporarily suppress H. pylori 1, 2
- Bismuth compounds: Withhold for at least 4 weeks before testing 1, 2
Why Sucralfate Is Not a Concern
Sucralfate is conspicuously absent from all major guideline recommendations regarding medications that interfere with H. pylori breath testing 2. The American College of Gastroenterology, American Gastroenterological Association, European Helicobacter Study Group, and Maastricht IV/Florence Consensus guidelines systematically reviewed medications affecting test accuracy, and sucralfate does not appear on these lists 1, 2.
Research evidence supports this guideline omission:
- A Japanese study specifically tested sucralfate's effect on the ¹³C-urea breath test and found it had no significant effect on test results when used alone 3
- While sucralfate does have some suppressive effect on H. pylori density in the gastric antrum, all patients remained CLOtest positive and overall gastric urease activity was unchanged, meaning the breath test would still detect the infection 4
Additional Medications With Minimal or No Effect
- H2-receptor antagonists (like ranitidine): May cause some false-negatives but to a much lesser extent than PPIs, and guidelines did not find it necessary to stop them when using citric acid test meals 2
- Other mucoprotective agents (ecabet sodium, rebamipide, teprenone, cetraxate hydrochloride): Have little effect on UBT results when used alone 3
Clinical Bottom Line
You can proceed with the urea breath test without stopping sucralfate. Focus your attention on ensuring the patient has discontinued PPIs for at least 2 weeks and antibiotics/bismuth for at least 4 weeks 1, 2. The patient should also fast for at least 6 hours before the test 1.