For Patients Taking PPIs

It is recommended that antibiotics, PPIs, or bismuth preparations not be taken within 2 weeks prior to administering BreathTek UBT.

  • If patients currently taking PPIs test positive for H. pylori infection, it is considered positive and eradication therapy can be started immediately; if the test is negative, it may be a false negative and results should be confirmed with a second breath test 2 weeks after discontinuing PPIs
  • Histamine 2-receptor antagonists (H2RAs) may be substituted for PPIs. These medications include Zantac® (ranitidine), Tagamet® (cimetidine), Pepcid® (famotidine), and Axid® (nizatidine). The effect of H2RAs may reduce urease activity on urea breath tests. H2RAs may be discontinued for 24-48 hours before the BreathTek UBT1
PPIs

Test for H. pylori infection before starting PPI therapy.

Approximately 60% of adult patients are already taking a PPI when they initially present with GI symptoms.2

  • Commonly used PPIs include Nexium® (esomeprazole magnesium), Prevacid® (lansoprazole), Prilosec® (omeprazole), Zegerid® (omeprazole/sodium bicarbonate), AcipHex® (rabeprazole sodium), Dexilant® (dexlansoprazole), and Protonix® (pantoprazole sodium)
  • Many patients resist discontinuing PPIs before testing because of concerns about symptom aggravation2

PPIs are commonly indicated for short-term therapy.

  • Patients typically stay on prescription PPI therapy for an average of 180 days3
  • Guidelines recommend a test-and-treat strategy for cases of uninvestigated dyspepsia1

Manufacturer-Recommended Duration of PPI Therapy

  Nexium®4 (esomeprazole magnesium) Prevacid®5,6* (lansoprazole)

Short-Term
Therapy

10 days to 8 weeksd,e 10 days to 12 weeksa,d,e

Long-Term
Therapy

Up to 6 monthsg,h Up to 12 monthsh,i
  Prilosec®7,8† (omeprazole) Zegerid®9,10‡ (omeprazole/sodium bicarbonate)

Short-Term
Therapy

10 days to 8 weeksa,b,d,e 2 weeks to 8 weeksa,b,c,e,f

Long-Term
Therapy

More than 5 yearsh,j Up to 12 monthsh
  Aciphex®11 (rabeprazole sodium) Dexilant®12 (dexlanso-prazole)

Short-Term
Therapy

7 days to 16 weeksa,d,e Up to 8 weeksc

Long-Term
Therapy

Up to 12 monthsj Up to 6 monthsh

Indications

a -Duodenal ulcers

b -Gastric ulcers

c -Erosive esophagitis

d -Eradication of H. pylori infection to reduce the risk of duodenal ulcer recurrence

e -Gastroesophageal reflux disease (GERD)

f -Risk of upper gastrointestinal bleeding in critically ill

g -Risk reduction of NSAID-associated gastric ulcers

h -Healing of erosive esophagitis

i -Maintenance of healed duodenal ulcers

j -Pathological hypersecretory conditions

Long-term PPI use may mask H. pylori infection and cause many side effects.13-16

*Includes Prevacid® 24 HR. Includes Prilosec OTC®. Includes Zegerid OTC®.

All registered marks are the property of their respective owners.

Abbreviations: NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.

References
  • Chey WD, Wong BCY; Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102(8):1808-1825.
  • Data on file. Otsuka America Pharmaceutical, Inc.
  • US Food and Drug Administration. FDA drug safety communication: low magnesium levels can be associated with long-term use of proton pump inhibitor drugs (PPIs). http://www.fda.gov/drugs/drugsafety/ucm245011.htm. Updated August 4, 2017. Accessed August 21, 2017.
  • Package Insert for Nexium. AstraZeneca Pharmaceuticals LP; 2014.
  • Package Insert for Prevacid. Takeda Pharmaceuticals America, Inc; 2016.
  • Package Label for Prevacid 24HR. http://general.takedapharm.com/content/file.aspx?filetypecode=PREVACIDPI&cacheRandomizer=8a59d3dd-883a-4a12-990d-936c608a6a70. Accessed August 21, 2017.
  • Package Insert for Prilosec. AstraZeneca Pharmaceuticals LP; 2016.
  • About Prilosec OTC: warnings and directions. Prilosec OTC website. https://www.prilosecotc.com/en-us/about-prilosec-otc/side-effects. Accessed August 21, 2017.
  • Package Insert for Zegerid. Santarus, Inc; 2014.
  • Package Label for Zegerid OTC. http://www.zegeridotc.com/download/zegeridotc_product_labeling.pdf. Accessed August 21, 2017.
  • Package Insert for AcipHex. Eisai Inc; 2014.
  • Prescribing Information for Dexilant. Takeda Pharmaceuticals America, Inc; 2016.
  • Spiegel BMR, Farid M, Van Oljen MGH, et al. Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers. Aliment Pharmacol Ther. 2009;29(8)871-881.
  • Chubineh S, Birk J. Proton pump inhibitors: the good, the bad, and the unwanted. South Med J. 2012;105(11):613-618.
  • Helicobacter pylori and peptic ulcer disease: the key to cure. Centers for Disease Control and Prevention website. http://www.cdc.gov/ulcer/keytocure.htm. Updated September 28, 2006. Accessed August 21, 2017.
  • Nasser SC, Slim M, Nassif JG, et al. Influence of proton pump inhibitors on gastritis diagnosis and pathologic gastric changes. World J Gastroenterol. 2015;21(15):4599-4606.