How long after Helicobacter pylori (H. pylori) treatment do you check for eradication?

From the Guidelines

Testing for Helicobacter pylori eradication should be performed at least 6 weeks after completing treatment and at least 2 weeks after proton pump inhibitor (PPI) withdrawal. This recommendation is based on the most recent and highest quality study available, which suggests that this waiting period is necessary to ensure accurate test results 1. The urea breath test or a monoclonal stool antigen test are the preferred methods for confirming eradication.

Key Considerations

• The waiting period allows for the bacterial load to recover to detectable levels if eradication was unsuccessful, while also giving sufficient time for true eradication to be confirmed if the treatment was effective.
• Patients should avoid taking PPIs for at least 2 weeks before the test, as these medications can interfere with test accuracy and lead to false negatives.
• For patients who require continued acid suppression, H2 receptor antagonists can be used until 24 hours before testing as they have less impact on test results than PPIs.

Treatment Outcomes

• Eradication of H. pylori with antibiotics can induce lymphoma regression and long-term clinical disease control in most patients with gastric MALT lymphoma.
• The length of time necessary to obtain a remission can vary from a few weeks to more than a year, and it is reasonable to wait for at least 12 months before starting another treatment in patients who achieve clinical and endoscopic remission together with eradication of H. pylori 1.

From the FDA Drug Label

H. pylori eradication was defined as no positive test (culture or histology) at 4 weeks following the end of treatment, and two negative tests were required to be considered eradicated of H. pylori. H pylori eradication was defined as 2 negative tests (culture and histology) at 4 to 6 weeks following the end of treatment.

Time to check for eradication:

• 4 weeks after the end of treatment 2
• 4 to 6 weeks after the end of treatment 3, 4

Key points:

• Eradication of H. pylori is defined as two negative tests (culture and histology) at 4 to 6 weeks following the end of treatment.
• The time to check for eradication is 4 weeks after the end of treatment, or between 4 to 6 weeks after the end of treatment.

From the Research

Eradication Check Timing

• The timing for checking eradication after Helicobacter pylori treatment varies, but most studies agree on a minimum of 4 weeks after treatment completion 5, 6, 7, 8.
• Specifically, a study published in Helicobacter in 2013 checked for H. pylori eradication by (13)C-UBT 4 or more weeks after treatment 5.
• Another study published in Gut in 2015 assessed H. pylori eradication 6 weeks after treatment using the 13C-urea breath test 6.
• A study in The Journal of antimicrobial chemotherapy from 2015 confirmed eradication at least 4 weeks after the end of treatment 7.
• An earlier study from 1998 checked H. pylori status by 13C urea breath test before and after four weeks of therapy 8.
• A 2012 study in the Journal of clinical biochemistry and nutrition did not specify the exact timing but mentioned that eradication rates were evaluated after treatment completion 9.

Key Findings

• The eradication check timing is generally consistent across studies, with most recommending a check at least 4 weeks after treatment completion 5, 6, 7, 8.
• The choice of treatment regimen can affect eradication rates, with some regimens showing higher success rates than others 5, 6, 7, 8, 9.