A 45-year-old man has a urea breath test performed for dyspepsia while continuing his proton pump inhibitor, started 5 days earlier. The test is reported negative. He remains symptomatic and H. pylori infection is still suspected. What is the most appropriate next step?
- A Perform a stool antigen test while he continues the PPI
- B Start empiric triple therapy without further testing
- C Repeat the urea breath test after stopping the PPI for 2 weeks ✓
- D Repeat the urea breath test within 48 hours off the PPI
Correct answer: C. Repeat the urea breath test after stopping the PPI for 2 weeks
Explanation
Proton pump inhibitors suppress gastric acidity, allowing overgrowth of urease-producing commensal organisms and reducing H. pylori load, which produces false negative results on urea breath testing and stool antigen testing. Standard practice is to withhold the PPI for at least 14 days before retesting. Serology is unaffected by PPIs but cannot distinguish active from past infection, so repeating the breath test after an adequate washout is correct.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.