Urea Breath Test Follow-Up: 2 or 4 Weeks Post-Treatment?

[mjfuter]

Hello all! I just completed follow-up H. Pylori urea breath and stool antigen tests 2 weeks post-treatment at LabCorp and the results came back negative which I'm certain are FALSE NEGATIVE as the same, miserable symptoms persist. These symptoms include recurring stomach pain, nausea, low-grade fevers, chills, night sweats and extreme fatigue.

I'd like to get more clarity on the suggested testing time intervals between each round of treatment since what I'm reading online, and what my doctors tell me, are very conflicting statements. My GI specialist and the LabCorp patient test menu have instructed me to stop using PPIs, antibiotics and bismuth for 2 weeks prior to follow-up testing, but Mayo Clinic Labs tells a different story:

"The patient should not have taken antibiotics, proton pump inhibitors (PPIs) or bismuth preparations for 2 weeks prior to the test. If PPIs are used within 2 weeks of BreathTek urea breath test (UBT) testing, false-negative test results may occur. Premature collection time can lead to a false-negative diagnosis for a patient with a marginally positive result."

And then 2 paragraphs later they change their mind and state this instead:

"The breath test should not be used until 4 weeks or more after the end of treatment for the eradication of H pylori as earlier posttreatment assessment may give false-negative results."

So which is it?!?

Thank you for your time!

[RadioFox87]

They recommend you stay off of antibiotics for four weeks and off of PPIs for two weeks prior to getting the retest. I would get a retest just to be safe. I waited about four weeks to get retested. This was my calendar:

June 29th: Started triple therapy.

July 12: Finish triple therapy( 14 days later).
July 27: I got off ppis, probiotics, etc.

August 12th: Stool retest.
- 16 days after stopping ppis
- 32 days after finishing triple therapy
August 14th: Endoscopy.
- 18 days after stopping ppis
- 34 days after stopping triple therapy

I was so unsure if my test was a true negative. I got a retest done in October too. Still negative.

[Helico_expert]

This is a guideline how to use breath/stool test.
https://helico.com/PYtest_guide_2013.pdf

the reason for the wait is to give time for the "survival" H. pylori to grow up in mass. The longer you wait, the more H. pylori you will get, and hence the less likely you will get a false negative.

Then again, this is based on the assumption that you have good acid production. Most people does. The elderly or people with damaged stomach may produce less acid, and the test will also fail.

[mjfuter]

Thank you both for your quick, informative replies to my questions!

By any chance, does the Helicobacter Foundation have any affiliates in the United States? If so, what about in the Dallas, Texas area? I ask because I'm not satisfied with the quality of care I'm receiving from the specialist physicians who are currently treating my H. Pylori infection. With the super slow progress I'm making on my current H. Pylori treatment plan, I'll be dead before this infection is eradicated!!

If any member of the Helicobacter Foundation can recommend a specialist physician local to the Dallas, Texas, US area, please let me know.

Thanks again!

[Helico_expert]

I'll PM you someone.

[mjfuter]

I'm not having any luck getting a positive on the BreathTek H. Pylori Urea Breath Test at Quest Diagnostics lately though my symptoms persist after multiple rounds of treatment. Here's a summary of the test results from my recent UBTs completed:

January 18, 2021
PPIs: 1 week off
Bismuth: 2 weeks off
Antibiotics: 2 weeks off
Still Using: DanActive probiotics drinks, Benefiber prebiotics chewable tablets, Opti Men men's multivitamins, Vitamin C 1,000mg, Pepcid Complete (as needed), Flonase Sensimist glucocorticoid nasal spray, Astilen antihistamine nasal spray
Test Result: NOT DETECTED

January 25, 2021
PPIs: 2 week off
Bismuth: 3 weeks off
Antibiotics: 3 weeks off
Still Using: DanActive probiotics drinks, Benefiber prebiotics chewable tablets, Opti Men men's multivitamins, Vitamin C 1,000mg, Pepcid Complete (as needed), Flonase Sensimist glucocorticoid nasal spray, Astilen antihistamine nasal spray
Test Result: NOT DETECTED

February 1, 2021
PPIs: 3 week off
Bismuth: 4 weeks off
Antibiotics: 4 weeks off
Still Using: DanActive probiotics drinks, Benefiber prebiotics chewable tablets, Opti Men men's multivitamins, Vitamin C 1,000mg, Pepcid Complete (as needed), Flonase Sensimist glucocorticoid nasal spray, Astilen antihistamine nasal spray
Test Result: NOT DETECTED

The Quest lab technician told me it's important that I do NOT drink any water or brush my teeth during the 1 hour time period prior to taking the Urea Breath Test. I must admit I did have a few sips of water and brush my teeth about 30-45 minutes prior to taking the test. Could this have affected my UBT results?

I'm really confused about why I cannot get a positive result on the H. Pylori Urea Breath Test yet my symptoms are slowly getting worse and worse the longer I stay off of eradication therapy (i.e. PPIs, bismuth, antibiotics). What am I doing wrong here? Should I continue taking the weekly UBTs in hopes of eventually getting a positive result? My GI specialist requires a positive result on the UBT prior to performing H. Pylori culture and susceptibility testing, which I plan to do, so I've got to get this right!!

[Helico_expert]

In order to get breath test to work, you need two conditions.
1. an acidic stomach.
2. lots of H. pylori in the stomach.

if you took PPI, then you would fail condition 1 and can get false negative result.
if you took antibiotics, then condition 2 would fail, and get false negative result.

3-4 weeks off PPI and antibiotics are good enough to get H. pylori grow back. So the result should be accurate.

However, as you grow older, your acid secretion may be poorer due to the damage by H. pylori. Then even if you did not take PPI, breath test wont work.

normally we would do a more thorough check on the breath test result. knowing positive and negative is not good enough. We need to know how negative is negative. If 4% is the cut off, and you got 3.9%. It is a negative, but we would call it a suspicious one.

drinking water and brushing teeth will not affect the test outcome.

So if you are above 50, you need an endoscopy to have a good check up.

[mjfuter]

I'm 40 years old by the way.

I agree that my H. Pylori UBT result should be accurate considering the amount of time I've been off of PPIs, bismuth and antibiotics medications, but the same, old symptoms remain and get progressively worse the longer I abstain from treatment.

I've had the UBT performed at both LabCorp and Quest Diagnostics and not once did they ever produce a QUANTITATIVE result on the final report. All of my results were reported QUALITATIVELY as "NOT DETECTED" with no supporting data to justify the conclusion.

Further investigation using the quantitative data to see how negative is my "NOT DETECTED" result on the UBT would be quite useful in my situation where the symptoms don't match the test result. I've contacted my GI specialist, based on your recommendation, asking him if it's possible to obtain the missing quantitative data from my UBTs. I'll follow up with you here if and when I ever get ahold of this missing information.

Thank you!

[Helico_expert]

Some patients can have delayed recovery, or "episodes" of symptoms, even after HP eradication.

The symptoms are actually caused by the inflammation triggered by H. pylori. So it depends on how quickly the inflammation subside after H. pylori eradication. Some damage caused by the inflammation may not be reversible. But without H. pylori, at least it not going to get worse.