Your doctor has scheduled you for a H. Pylori Breath Test to determine if you are infected with this bacterium.

Your test is set for:_____________________________

Test will be conducted at:________________________

If you have any questions regarding the following instructions, please call our office at 612-871-1145.

This simple breath test to detect the bacteria helicobacter pylori takes approximately 15 min. First you will be asked to blow a breath of air into a small collection bag. Next, you will drink an 8 ounce citrus flavored solution. After 15 minutes you will blow a breath of air into a second collection bag. NOTE: If you have Phenylketonuria (PKU) and restrict dietary phenylalanine please call the number listed above.

If you have been treated for H-Pylori infection, treatment must be completed at least 4 weeks prior to the test. Patients need to be off all antibiotics for 4 weeks prior to the test and Proton Pump Inhibitors and/or Bismuth type medications 2 weeks prior to the test.
Note: Bismuth medications are Pepto-Bismol and all generic forms.

Antibiotics must be completed by:_________________________________

Stop taking Proton Pump Inhibitors and Bismuth on:___________________

Proton Pump Inhibitors include:

Note: You can continue to take H2 Blockers, such as Tagamet, Zantac, Axid and Pepcid as well as Antacids, such as Maalox, Rolaids, Tums, and Mylanta.

Day of Test: Patient must fast for 1 hour prior to the test. This means nothing to eat or drink after ____________________________________