From the Guidelines
The recommended follow-up test to confirm H. pylori eradication is the urea breath test (UBT), which should be performed at least 4 weeks after completion of treatment, as stated in the most recent study 1. This non-invasive test offers excellent sensitivity and specificity for detecting active infection. Alternatively, the stool antigen test is an acceptable option with similar accuracy, as supported by studies 1. It's crucial to wait at least 4 weeks after completing antibiotic therapy and 2 weeks after stopping proton pump inhibitors (PPIs) before testing, as these medications can lead to false-negative results, as noted in 1 and 1. Serological tests are not recommended for confirmation of eradication since antibodies may persist for months or years after successful treatment. Confirmation of eradication is important because failed treatment may lead to antibiotic resistance, requiring alternative regimens. For patients with complicated ulcers, MALT lymphoma, or persistent symptoms despite treatment, endoscopy with biopsy might be warranted instead of non-invasive testing to directly visualize the gastric mucosa and obtain tissue samples for histology and culture, as suggested in 1 and 1.
Some key points to consider:
- The UBT and stool antigen test are the preferred methods for confirming H. pylori eradication, due to their high accuracy and non-invasive nature.
- PPIs and antibiotics can interfere with test results, so it's essential to wait for the recommended period before testing.
- Serological tests are not reliable for confirming eradication, as antibodies can persist long after treatment.
- Endoscopy with biopsy may be necessary for certain patients, such as those with complicated ulcers or MALT lymphoma.
Overall, the choice of follow-up test should be based on the individual patient's needs and medical history, with consideration of the potential benefits and limitations of each test, as discussed in 1 and 1.
From the FDA Drug Label
H pylori eradication was defined as 2 negative tests (culture and histology) at 4 to 6 weeks following the end of treatment. The recommended follow-up test to confirm eradication of H. pylori infection after treatment is 2 negative tests (culture and histology) at 4 to 6 weeks following the end of treatment 2.
- Key points:
- Two negative tests are required to confirm eradication
- Tests should be performed 4 to 6 weeks after the end of treatment
- Culture and histology are the recommended tests for confirmation of eradication
From the Research
Follow-up Test for H. pylori Eradication
To confirm the eradication of H. pylori infection after treatment, the following tests are recommended:
Test Characteristics
The characteristics of these tests are as follows:
- UBT: high sensitivity and specificity, but may be affected by proton pump inhibitor (PPI) use 4, 5
- SAT: high sensitivity and specificity, less likely to be affected by PPI use 6, 7, 5
- Rapid Urease Test (RUT): high sensitivity, but may be less specific than UBT and SAT 7
- Serology: low sensitivity and specificity, not recommended for diagnosis 7
- Histology: high sensitivity and specificity, but invasive and requires endoscopy 4, 7
Test Selection
The choice of test depends on various factors, including patient symptoms, medical history, and current medication use. According to the studies, SAT is a reliable and non-invasive test for diagnosing H. pylori infection, with high sensitivity and specificity 3, 6, 7. UBT is also a commonly used test, but its sensitivity may be affected by PPI use 4, 5.
Proton Pump Inhibitor Use
PPI use can lead to false-negative results in UBT and SAT, so it is recommended to stop PPI therapy for 1-2 weeks before testing if possible 4, 5. However, some studies suggest that SAT may be less affected by PPI use than UBT 6, 5.