New Protocol for H. pylori Urea Breath Test

Laurie Barclay, MD

January 10, 2003

Jan. 10, 2003 -- Current guidelines recommend discontinuing proton pump inhibitors (PPIs) before performing the urea breath test for H. pylori. A new test protocol reported in the January issue of the American Journal of Gastroenterology incorporates a test drink of citric acid, which reduces the false-postive rate so that discontinuing acid suppressive therapy is not necessary.

"The use of PPIs and of histamine H2-blockers may result in false negative results during diagnostic urea breath tests (UBT); therefore, cessation of PPIs and H2-blockers 7-14 days before UBT is currently recommended," write Haim Shirin, MD, and colleagues from the E. Wolfson Medical Center in Holon, Israel. "However, for 'PPI dependent' patients this may be a critical issue, because PPI withdrawal is strongly associated with symptom recurrence."

In this prospective study, 52 consecutive patients who were receiving PPIs and who were positive for H. pylori by BreathID, a new, continuous real time 13C-urea breath test, were randomized to receive either omeprazole 20 mg/day or pantoprazole 40 mg/day for 14 days. Complete test data was available for 43 patients.

After 14 days of treatment with PPIs, only 1 (2.3%) of 43 patients examined by BreathID was false-negative for H. pylori compared with 2 (4.6%) of 43 patients examined by isotope ratio mass spectrometry (IRMS). Except for one case, there was complete agreement between BreathID and IRMS breath tests both at baseline and after PPI treatment.

BreathID revealed three different types of responses to PPI treatment. One-third of patients had a significant decrease in excretion of 13CO2/ 12CO2, one-third had a significant increase in the post-PPI breath test results, and about one-third had no significant change. Linear regression analysis of 43 H. pylori-positive subjects indicated a significant positive association between baseline and post-PPI 13CO2/ 12CO2 excretion.

"The use of a single test drink containing 4.0 g citric acid in BreathID, resulted in a low number of false negative results associated with sustained PPI treatment," the authors write. "Although there were some differences between BreathID versus IRMS, the type of PPI and the sampling method used do not appear to play a critical role in the detection of H. pylori by BreathID. According to these results, BreathID is a reliable tool for testing H. pylori in patients taking PPIs."

Am J Gastroenterol. 2003;98(1):46-50

Reviewed by Gary D. Vogin, MD