Helicobacter pylori Antigen, Pediatric 3-17 years

Last Modified: 3/27/2019 2:57:54 PM

Medical Necessity Documentation:  
Client Notes:  
Patient Preparation: This test can only be performed on specimens from patients 3-17 years old

Patient should fast one hour before collection of baseline breath sample. Pranactin®-Citric contains a small amount of aspartame sweetener. Test may not be suitable for patients with phenylketonuria whose dietary phenylalanine should be restricted.

Use of antimicrobials, proton pump inhibitors, or bismuth preparations within two weeks prior to administering the BreathTek™ UBT may cause a false negative result. However, a positive result is still valid.

Specimen Requirements: Paired breath samples (pre and post) collected in BreathTek™ UBT Collection Kit bags must be submitted together.
Collection Instructions: Follow instructions provided with kit

Gender, height, weight, and age, must be provided on the pediatric UHR card included in the BreathTek™ UBT Collection Kit.
Transport & Storage: Temperature/Stability: 7 days Ambient
Rejection Criteria: Specimen types other than BreathTek™ UBT bags • Specimens from patients <3 years old; Refrigerated; Frozen
Reference Range: Not Detected
Critical Ranges:  
Test Comments:  
Methodology: Infra-red Spectrophotometry (IR)
Clinical Significance: 92491
Custom Panel: No


Turn Around Time: 1 to 3 days
Days Performed: Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Quest - Chantilly
PHL Test Code: HPPED
EPIC Test Code: LAB2976
Send Out Test Code: 92491 (92491CL)
Alternate Test Names: Breath Test; H pylori; H pylori Breath, Peds; H. pylori; H. pylori Breath, Peds; UBiT; Urea Breath Test
Included Tests:  
CPT Coding: 83013

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