How long should Proton Pump Inhibitor (PPI) medication be stopped before testing for Helicobacter pylori (H. pylori)?

From the Guidelines

It is recommended to stop proton pump inhibitor (PPI) medications for at least 2 weeks before testing for Helicobacter pylori (H. pylori). This recommendation is based on the most recent and highest quality study available, which suggests that stopping PPIs for 2 weeks allows the bacteria to repopulate the stomach, increasing the accuracy of diagnostic tests 1. Common PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex).

The use of PPIs can lead to false-negative test results due to the reduction of stomach acid production, which decreases the number of H. pylori bacteria present in the stomach 1. During this 2-week period, if acid reflux symptoms become problematic, antacids like Tums or Rolaids can be used as they don't significantly affect H. pylori testing accuracy.

Some key points to consider when testing for H. pylori include:

• Stopping antibiotics for 4 weeks before testing as they can also suppress H. pylori and cause false-negative results
• Stopping H2 blockers like ranitidine or famotidine 24-48 hours before testing
• Using noninvasive tests such as urea breath tests or stool antigen tests, which are susceptible to any action that decreases the bacterial load in the stomach
• Considering the use of serologic tests, such as IgG anti-H. pylori tests, which remain positive long after the infection has been eradicated, but are not recommended for therapeutic decisions without confirmation by a urea breath test, stool antigen test, or endoscopy 1.

Overall, temporarily stopping acid-suppressing medications is crucial for obtaining reliable results when testing for H. pylori, and the recommended 2-week waiting period is based on the most recent and highest quality evidence available 1.

From the FDA Drug Label

1. 10 Interactions with Diagnostic Investigations for Neuroendocrine Tumors Serum chromogranin A (CgA) levels increase secondary to drug-induced decreases in gastric acidity. The increased CgA level may cause false positive results in diagnostic investigations for neuroendocrine tumors Healthcare providers should temporarily stop omeprazole treatment at least 14 days before assessing CgA levels and consider repeating the test if initial CgA levels are high.

Stopping PPI medication before testing: Healthcare providers should temporarily stop omeprazole treatment at least 14 days before assessing certain diagnostic investigations, such as CgA levels for neuroendocrine tumors. However, this information is specific to neuroendocrine tumor testing and does not directly address H. pylori testing. The FDA drug label does not answer the question.

From the Research

Stopping PPI Medication Before Testing H. Pylori

To determine the appropriate duration for stopping PPI medication before testing for H. pylori, several studies provide relevant information:

• A study from 2015 2 suggests that detecting PPI use and stopping it 2 weeks before testing is the preferred approach to improve the reliability of H. pylori diagnostic tests.
• Another study from 2016 3 found that cessation of PPI consumption at least 12 days before endoscopy could help avoid false-negative results of H. pylori diagnostic tests.
• A 2007 study 4 recommends stopping PPI treatment for 1-2 weeks prior to testing if possible.
• However, a 2023 study 5 found that the stool antigen test may be less likely to yield false-negative results, even when PPIs are being used, particularly when using domestically produced kits.
• An earlier study from 2004 6 found that the sensitivity of breath tests and stool tests is decreased with the administration of proton pump inhibitors, but antacids do not impair the sensitivity of these tests.

Key Findings

• The duration for stopping PPI medication before testing H. pylori varies among studies, with recommendations ranging from 1-2 weeks 4 to at least 12 days 3.
• The type of test used may also impact the need for stopping PPI medication, with stool antigen tests potentially being less affected by PPI use 5.
• Antacids do not appear to impair the sensitivity of breath tests or stool tests 6.