How should I interpret the results of a urea breath test for H. pylori in a symptomatic patient?

Interpreting a urea breath test (UBT) for Helicobacter pylori in a symptomatic patient:

• A positive urea breath test indicates active H. pylori infection, as the test detects urease activity specific to the bacteria, making it highly sensitive and specific (about 95%) for active infection in symptomatic patients.
• A negative urea breath test generally excludes active H. pylori infection, but false negatives can occur if the patient has recently taken antibiotics or proton pump inhibitors (PPIs), which suppress bacterial activity; therefore, these medications should be stopped at least 2 weeks before testing to avoid false negatives.
• Serological tests are not recommended for diagnosis or confirmation of eradication because they cannot distinguish between active and past infection and have a higher false positive rate compared to UBT.
• In symptomatic patients who test positive, eradication therapy is recommended as it is effective and cost-effective for ulcer healing and symptom control.
• Re-testing with a urea breath test is advised at least 4–8 weeks after completion of eradication therapy to confirm successful treatment.

Overall, the urea breath test is the preferred diagnostic and re-testing method for H. pylori in symptomatic patients due to its accuracy and ability to detect active infection, guiding appropriate treatment decisions.

References: ¹,²,³,⁴