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Order Code HPYBR Helicobacter pylori Breath Test

Additional Codes

Mayo Test ID
UBT

Reporting Name

H. pylori C Urea Breath Test

Useful For

Diagnostic testing for Helicobacter pylori infection in patients suspected to have active H pylori infection

 

Monitoring response to therapy

Specimen Type

Breath


Advisory Information


An alternative test for the diagnosis of active Helicobacter pylori infection in patients is the HPSA / Helicobacter pylori Antigen, Feces, which requires a different collection.



Necessary Information


For patients between 3 and 17 years old, complete the Pediatric UHR Calculation Information card: See Special Instructions for link to required form.

 



Specimen Required


Patient Preparation:

1. Patient should be fasting for 1 hour.

2. Patients should not have taken bismuth/Tritec, antibiotics, proton-pump inhibitors (eg, Prilosec, Prevacid, Aciphex, Protonix, and Nexium) or Pepto-Bismol for 2 weeks prior to testing. If these instructions are not followed, test results may be inaccurate.

3. Histamine 2-receptor antagonists (H[2]RAs) such as Pepcid, Tagamet, Axid, or Zantac should be discontinued for 24 to 48 hours before the BreathTek UBT test is administered. If these instructions are not followed, test results may be inaccurate.

4. Carafate (sucralfate) does not interfere with the test. Use of antacids does not affect the accuracy of this assay.

Supplies: H. Pylori Breath Kit (T375: fees apply)

Collection Instructions:

1. Do not collect if patient is younger than 3 years of age.

2. Follow instructions included with kit.


Ridgeview Medical Center Note:

How to Administer BreathTek UBT in 4 Simple Steps:

Step 1:  For BLUE Baseline Collection Bag:

Collect baseline sample by having the patient inhale, hold their breath momentarily, then exhale into the blue bag. Place cap on the bag and press down until it snaps to prevent sample loss.

 

Step 2:  For Solution Administration:

Thoroughly mix the entire Pranactin®-Citric packet with water in the plastic container. Close the lid securely by pressing down until you hear a click and swirl until dissolved up to 2 minutes. The patient must drink the solution using the plastic straw provided.

 

Step 3:  Wait 15 minutes.

 

Step 4:  For PINK Post-Dose Collection Bag:

Collect the second breath sample in the pink bag using the same procedure as Step 1. Breath sample may be collected no later than 30 minutes POST-DOSE. Place cap on the bag and press down until it snaps to prevent sample loss.

Specimen Minimum Volume

Bag of ’’breath’’ must be full

Specimen Stability Information

Specimen Type Temperature Time Special Container
Breath Ambient 7 days BREATH TEST BAG

Reject Due To

Hemolysis NA
Lipemia NA
Icterus NA
Other NA

Reference Values

Negative

Reference values apply to all ages.

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Day(s) and Time(s) Performed

Monday through Friday, Sunday; 6:30 a.m.-5 p.m.

Method Name

Infrared Spectrophotometry (SP)

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

83013

LOINC Code Information

Test ID Test Order Name Order LOINC Value
UBT H. pylori C Urea Breath Test 29891-9

 

Result ID Test Result Name Result LOINC Value
81590 H. pylori C Urea Breath Test 29891-9

Testing Algorithm

See Helicobacter pylori Diagnostic Algorithm in Special Instructions

Forms

1. For patients between 3 and 17 years old, the Pediatric UHR Calculation Information card is required, see Special Instructions.

2. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Microbiology Test Request (T244)

-Gastroenterology and Hepatology Client Test Request (T728)

-General Request (T239)