Current or recent proton pump inhibitor therapy markedly impairs the accuracy of the [14C]urea breath test

A El-Nujumi, T E Hilditch, C Williams, K E McColl

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Abstract

BACKGROUND: There are increasing indications for assessing Helicobacter pylori status by non-invasive means in dyspeptic patients. There is also increasing use of proton pump inhibitor therapy for dyspeptic disease.

AIMS: To determine the effect of proton pump inhibitor therapy on the accuracy of the [14C]urea breath test.

PATIENTS: [14C]Urea breath tests were performed in 20 H. pylori-positive and 13 H. pylori-negative dyspeptic patients before commencing omeprazole and after 4 weeks of treatment with 40 mg/day and then 6 months of treatment with 20 mg/day. Further studies were done in H. pylori-positive patients to examine the time course of the onset and resolution of the effect observed.

RESULTS: False negative results occurred in 45% of the H. pylori-positive subjects after 4 weeks of omeprazole 40 mg/day and in 28% after 6 months of 20 mg/day. False positive results occurred in 15% of the H. pylori-negative subjects after 4 weeks of omeprazole 40 mg/day. In the H. pylori-positive subjects time course studies showed increasing suppression of the breath test result over the first 2-4 weeks of treatment. It took a similar time for the breath test result to recover after stopping treatment. There was no significant change in H. pylori IgG serology in the H. pylori-positive patients after 7 months of omeprazole treatment.

CONCLUSIONS: Proton pump inhibitor therapy markedly impairs the accuracy of the [14C]urea breath test and, in particular, produces a high proportion of false negative results. The effect is dose related and may persist for 2-4 weeks after stopping therapy. Patients should be carefully questioned about recent proton pump inhibitor therapy before accepting a negative breath test result as reliable.

Original languageEnglish
Pages (from-to)759-64
Number of pages6
JournalEuropean Journal of Gastroenterology & Hepatology
Volume10
Issue number9
Publication statusPublished - Sep 1998

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Keywords

  • Anti-Ulcer Agents
  • Antigens, Bacterial
  • Breath Tests
  • Dyspepsia
  • False Negative Reactions
  • False Positive Reactions
  • Helicobacter Infections
  • Helicobacter pylori
  • Humans
  • Immunoglobulin G
  • Omeprazole
  • Proton Pump Inhibitors
  • Sensitivity and Specificity
  • Time Factors
  • Urea
  • Journal Article

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