H. pylori Breath Test

Label Mnemonic: UBT
Epic code: LAB9309
Downtime form: Doctor/Provider Orders - Pathology Core and Specialty Care Nursery
Commercial Mailout Laboratory
6240-8 RCP
356-8593
Specimen(s):
Breath
Specimen Instructions:

Specimen Preparation:

  1. Label breath collection bags with patient name, MRN, date and time of collection, and indicate Pre (blue) or Post (pink).
  2. Collect the baseline (Pre) breath specimen according to the instructions in the IDkit HpTwo Breath Test Kit.
  3. After the allotted time, collect the Post breath specimen according to the instructions in the kit.

For a valid result, the post breath specimen must be collected between 15 and 20 minutes after the patient drinks the Citrica solution.

Collection Medium:
H. pylori Breath Test Kit
Rejection Criteria:

Underinflated or uncapped bags. Specimens from patients younger than 3 years. Specimens collected using the BreathTek UBT Kit (blue and pink collection bags).

Delivery Instructions:
Critical room temperature. Do not refrigerate or freeze.
Turn Around Time:

1–4 days upon receipt at reference laboratory

Reference Range:

Negative

Interpretive Data:

A negative result does not rule out the possibility of Helicobacter pylori infection. If clinical signs are suggestive of H. pylori infection, retest with a new specimen or an alternate method.

 

Known causes of false-negative results include:

  1. Ingestion of antimicrobials, proton pump inhibitors, and bismuth preparations during the preceding 2 weeks.
  2. Administration of the breath test less than 6 weeks after completion of definitive therapy to eradicate H. pylori.
  3. Premature or late collection of the post dose specimen.

Known causes of false-positive results include:

  1. Patients with achlorhydria.
  2. Rinsing the testing solution in the mouth or not using the straw provided in the kit, which can allow contact with urease-positive bacteria.
  3. The presence of other gastric spiral organisms such as Helicobacter heilmannii.

Note: The post-dose sample must be collected between 15- and 20-minutes post-dose to prevent a false negative result.

Comments:

Patient preparation

 

Remind the patient that there is 84 mg of phenylalanine per packet of Citrica Powder. Phenylketonurics restrict dietary phenylalanine.

 

The patient should have fasted at least one hour before administering the solution. The patient should not have taken antimicrobials (i.e., antibiotics), proton pump inhibitors (e.g., Prilosec, Prevacid, Aciphex, Nexium, Zegerid, Dexilant, Protonix), or bismuth preparations (e.g., Pepto Bismol) within two weeks prior to administering the test.

 

The effect of histamine 2-receptor antagonists (e.g., Axid, Pepcid, Tagamet, Zantac) may reduce urease activity and should be discontinued 24-48 hours before the sample is collected. Use of antacids (e.g., Tums, Milk of Magnesia, Rolaids, Mylanta, Gaviscon, Alka-Seltzer) does not appear to affect the accuracy of the test.

 

Order this test to diagnose H. pylori infection.

 

Testing kits are available from Specimen Control, 6240 RCP.

 

Test administration

  1. Label breath collection bags with patient name, MRN, date and time of collection, and indicate Baseline (blue) or Post Ingestion (gray).
  2. Collect the baseline (Pre) breath specimen according to the instructions in the IDkit HpTwo Breath Test kit. Instruct the patient to hold their breath for 4–5 seconds and then exhale into the blue Baseline collection bag until the bag is full.
  3. Prepare the test drink by adding 150 to 200 mL (5.1 to 6.8 oz.) water, the Citrica Powder, and the urea tablet to the provided drinking cup, closing the lid firmly, and shaking thoroughly until the powder and tablet are completely dissolved.
  4. Administer the test drink within two hours of preparation per kit instructions and precautions. Regardless of age and body weight, the patient must consume the entire solution through the provided straw within 2 minutes.
  5. Collect the gray Post Ingestion specimen 15 minutes after ingestion of the test drink, but no later than 20 minutes post ingestion. Instruct the patient to hold their breath for 4–5 seconds and then exhale into the gray Post Ingestion collection bag until the bag is full.
  6. Ensure the caps on the bag mouthpieces are secured (push until they click).

Return kit to Specimen Control, 6240 RCP.

 

Sample stability: 1 week only-must reach reference laboratory within a week of collection. Critical ambient.

 
Methodology:

Qualitative Spectrophotometry

CPT Code:
83013
 
See Additional Information:
Fasting Specimen Requirements