From the Guidelines
After completing treatment for H. pylori, follow-up testing is recommended at least 6 weeks after therapy ends to confirm eradication, as stated in the most recent guideline 1. The preferred test is either a urea breath test or a monoclonal stool antigen test, as these are non-invasive and highly accurate 1. Some key points to consider when following up after H. pylori treatment include:
- Stopping proton pump inhibitors (like omeprazole) at least 2 weeks before testing and antibiotics 4 weeks before to avoid false negative results 1
- Using a urea breath test or stool antigen test to confirm eradication, rather than blood antibody tests which can remain positive for months or years after successful treatment 2, 1
- Considering second-line therapy with a different antibiotic combination if the follow-up test shows persistent infection 1
- Evaluating the need for continued acid suppression therapy in patients with concurrent conditions like GERD, even after successful eradication 2
- Assessing the need for long-term follow-up after confirmed eradication, taking into account factors such as symptoms, history of gastric ulcers, or family history of gastric cancer 2, 1
In terms of specific patient populations, such as those with gastric MALT lymphoma, eradication of H. pylori with antibiotics should be the sole initial therapy, with follow-up testing to confirm eradication and assess lymphoma regression 1, 3. The outcome of eradication therapy should be checked by a urea breath test (or by a monoclonal stool antigen test) at least 6 weeks after starting eradication therapy and at least 2 weeks after PPI withdrawal 1, 3. It is reasonable to wait for at least 12 months before starting another treatment in patients who achieve a clinical and endoscopic remission together with eradication of H. pylori, albeit having persistent (residual) lymphoma at the histological level 3.
From the FDA Drug Label
The combination of omeprazole plus clarithromycin plus amoxicillin was effective in eradicating H. pylori. H. pylori status was determined by CLOtest®, histology and culture in all three studies. For a given patient, H. pylori was considered eradicated if at least two of these tests were negative, and none was positive.
Follow-up after treatment for H. pylori should include:
- Confirmation of H. pylori eradication using tests such as CLOtest®, histology, and culture.
- Assessment of duodenal ulcer healing to ensure that the ulcer has healed and to reduce the risk of recurrence.
Monitoring for ulcer recurrence at 6 and 12 months post-treatment to ensure that the ulcer does not recur.
From the Research
Follow-up after Treatment for H. pylori
- The follow-up process after treatment for H. pylori typically involves non-invasive tests to verify eradication of the infection 7, 8, 9.
- Non-invasive stool tests, such as the stool antigen test (SAT), can be used to verify successful H. pylori eradication and determine clarithromycin resistance 7.
- The urea breath test (UBT) is also a commonly used non-invasive test for diagnosing and monitoring H. pylori infection 10, 8, 9.
- A novel stool antigen test has been developed, showing high sensitivity and specificity for diagnosing H. pylori infection in a medical checkup setting 8.
- Non-invasive tests can be categorized into "active tests" that detect active infection (e.g., UBT, SAT) and "passive tests" that are markers of exposure to H. pylori but do not indicate if active infection is ongoing (e.g., serology) 9.
Diagnostic Tests
- The sensitivity and specificity of different diagnostic tests for H. pylori infection vary:
Treatment and Resistance
- Clarithromycin resistance is a major challenge in H. pylori eradication therapy, with a reported resistance rate of 13.4% 7.
- The use of non-invasive stool tests can help identify clarithromycin resistance and personalize antibiotic treatment strategies 7.
- Primary treatment for H. pylori infection typically involves triple therapy, with quadruple therapy recommended if standard triple therapy fails 10.