From the Guidelines
The urea breath test (UBT) is the preferred method for confirming H. pylori eradication after treatment. This non-invasive test measures carbon dioxide in the breath after the patient ingests urea labeled with carbon-13 or carbon-14. If H. pylori is present, its urease enzyme breaks down the urea, releasing labeled carbon dioxide that can be detected in the breath. Alternatively, the stool antigen test is also effective and widely available, as supported by the 2020 study 1. Both tests should be performed at least 6 weeks after starting eradication therapy and at least 2 weeks after PPI withdrawal, as recommended in the 2020 guidelines 1.
Key Considerations
- Acid-suppressing medications can temporarily suppress H. pylori and reduce bacterial load, interfering with test accuracy.
- Serological tests are not recommended for eradication confirmation as antibodies may remain positive for months or years after successful treatment, as noted in the 1997 study 1.
- For patients who have undergone endoscopy initially, repeat endoscopy with biopsy for histology, rapid urease testing, or culture is another option, though more invasive.
- Testing for eradication is particularly important in patients with complicated ulcer disease, MALT lymphoma, or persistent symptoms despite treatment, as emphasized in both the 1997 1 and 2020 studies 1.
Test Timing and Selection
- The UBT or stool antigen test should be performed at least 6 weeks after starting eradication therapy and at least 2 weeks after PPI withdrawal 1.
- The choice of test may depend on patient factors, such as the presence of complicated ulcer disease or MALT lymphoma, which may require more invasive testing, such as endoscopy with biopsy.
From the Research
H pylori Eradication Testing
To determine the most suitable test for H pylori eradication testing, several options are available. The key is to select a test that is non-invasive, accurate, and reliable.
- Urea Breath Test (UBT): This test is highly recommended for diagnosing H pylori infection and assessing the efficacy of eradication regimens 2, 3. The 13C-UBT is a preferred diagnostic approach due to its high accuracy, specificity, and non-radioactive nature, making it suitable for patients of all ages, including children and pregnant women 3.
- Stool Antigen Test (SAT): This test is also a viable option for diagnosing H pylori infection, with high sensitivity and specificity 4. However, its accuracy may be affected by recent antibiotic use or proton pump inhibitor therapy.
- Other Tests: Other diagnostic tests, such as serology, endoscopy with biopsy, and histology, are available but may have limitations, such as invasiveness, cost, or complexity 5, 6.
Test Selection Criteria
When selecting a test for H pylori eradication testing, consider the following factors:
- Accuracy and Reliability: Choose a test with high sensitivity and specificity to ensure accurate results.
- Non-invasiveness: Opt for a non-invasive test to minimize patient discomfort and risk.
- Cost and Availability: Consider the cost and availability of the test, as well as the need for specialized equipment or expertise.
- Patient Factors: Take into account patient-specific factors, such as age, pregnancy status, and recent medication use, when selecting a test.