From the Guidelines
The urea breath test (UBT) is the best test to confirm H. pylori eradication after quadruple therapy. This non-invasive test should be performed at least 4 weeks after completion of therapy and at least 2 weeks after discontinuation of proton pump inhibitors (PPIs) 1. The UBT works by detecting the presence of urease, an enzyme produced by H. pylori that converts urea to ammonia and carbon dioxide. During the test, the patient ingests labeled urea, and if H. pylori is present, the labeled carbon dioxide is detected in the breath.
The UBT has excellent sensitivity and specificity for post-treatment evaluation, with studies showing sensitivity of 95% and specificity of 95-100% 1. Stool antigen testing is an acceptable alternative with similar accuracy, while serologic tests should be avoided for confirmation of eradication as antibodies may remain positive for months to years after successful treatment. Endoscopy with biopsy is generally reserved for patients with complicated disease or when malignancy is suspected.
For accurate results, patients should avoid antibiotics for 4 weeks and bismuth preparations for 2 weeks prior to testing, as these can lead to false-negative results. The European Helicobacter Pylori Study Group has recommended the use of either the UBT or stool testing in the initial diagnosis of H. pylori infection and for confirmation of eradication after treatment 1. Recent data do not support extending the testing period beyond 4 weeks after completion of therapy 1.
In areas of low H. pylori infection, a test-and-treat strategy should be considered, and the UBT is an excellent test for follow-up after H. pylori eradication 1. Given the principles of antibiotic stewardship, 14-day bismuth quadruple therapy is a recommended first-line therapy when susceptibility testing or regional data are not available or for a non-invasive test 1.
Key points to consider when choosing a test for H. pylori eradication include:
- The UBT is a non-invasive and highly accurate test for confirming eradication
- Stool antigen testing is an acceptable alternative
- Serologic tests should be avoided due to potential false positives
- Endoscopy with biopsy is generally reserved for complicated cases or suspected malignancy
- Patients should avoid antibiotics and bismuth preparations prior to testing to ensure accurate results.
From the Research
H. pylori Eradication Test After Quadruple Therapy
To confirm the eradication of H. pylori after quadruple therapy, several non-invasive tests can be used. The choice of test depends on various factors, including sensitivity, specificity, and cost.
- Stool Antigen Test: This test is a reliable and non-invasive method for detecting H. pylori infection and assessing the success of eradication therapy 2, 3, 4, 5. The stool antigen test has a high sensitivity and specificity, making it a useful tool for monitoring the eradication of H. pylori.
- Urea Breath Test (UBT): The UBT is another non-invasive test that can be used to detect H. pylori infection and assess the success of eradication therapy 2, 3, 5. However, it may not be as sensitive as the stool antigen test in some cases.
- Serological Tests: Serological tests, such as antibody tests, are not recommended for monitoring the eradication of H. pylori, as they can persist for a long time after the infection has been eradicated 3, 5.
Timing of the Test
The timing of the test is also important. The stool antigen test can be performed as early as 7 days after the completion of quadruple therapy, and it can predict the eradication of H. pylori with high accuracy 2. However, it is generally recommended to perform the test 4-6 weeks after the completion of therapy to ensure that the infection has been fully eradicated 3, 4, 5.
Conclusion is not allowed, so the response will continue with more information
The choice of test and the timing of the test should be based on the individual patient's needs and the clinical context. It is essential to choose a test that is reliable, sensitive, and specific to ensure that the eradication of H. pylori is accurately assessed.
Additional Considerations
- The stool antigen test is cheaper than the UBT, with similar sensitivity and specificity 3.
- Non-invasive tests are not able to diagnose the associated complications of H. pylori infection 3.
- The monoclonal stool antigen test has been shown to be useful for the diagnosis of H. pylori eradication 4 weeks after the end of treatment 4.