From the Guidelines
Confirmatory testing for Helicobacter pylori (H. pylori) eradication is indicated in certain situations after treatment.
Indications for Confirmatory Testing
- Complicated peptic ulcer disease
- Gastric ulcer
- Low-grade gastric MALT lymphoma
- When compliance is poor
- In cases where symptoms recur after eradication 1
Testing Methods
- Endoscopy-based testing using biopsy specimens from the antrum and body is recommended in complicated cases, as it allows for histological assessment of mucosal abnormalities 1
- Non-invasive tests, such as the 13C-UBT, can be used in uncomplicated cases, with a minimum of 4 weeks after cessation of treatment 1
Timing of Confirmatory Testing
- The proposed period of 4 weeks after treatment has been questioned, but recent data do not support extending it to 6 or 8 weeks 1
- In cases of upper gastrointestinal bleeding, a delayed test, 4 to 8 weeks after the bleeding episode, is recommended 1
From the Research
Confirmatory Testing for H. pylori Eradication
- Confirmatory testing for H. pylori eradication after treatment is a topic of discussion among clinicians, with some guidelines recommending it in certain scenarios 2, 3, 4.
- The American College of Gastroenterology (ACG) endorses the carbon 13-labeled urea breath test ((13)C-UBT) as the most reliable test to confirm H. pylori eradication 3.
- A study found that patients' desire for confirmation of cure, coupled with a frequent need for confirmatory testing as a result of recurrent symptoms after therapy, may justify routine confirmatory testing after H. pylori treatment 2.
- Another study suggested that testing for H. pylori eradication resulted in a benefit of 0.07 quality-adjusted life-years and cost $836 less than the strategy of not confirming eradication 4.
Indications for Confirmatory Testing
- Confirmatory testing is indicated after treatment in patients with H. pylori-associated peptic ulcer disease, especially if symptoms recur 2, 4.
- It is also recommended in patients who have had endoscopic resection of early gastric cancer, and patients with a gastric mucosa-associated lymphoid tissue lymphoma (MALToma) 3.
- However, the necessity of confirmatory testing in asymptomatic patients after treatment is still a topic of debate 2, 5.
Factors Influencing Confirmatory Testing
- Patient factors, such as age, symptoms, and willingness to pay, can influence the decision to undergo confirmatory testing 2, 6.
- The choice of testing method and the availability of resources can also impact the decision to perform confirmatory testing 3, 5.
- Clinician factors, such as adherence to guidelines and awareness of antibiotic resistance patterns, can also influence the decision to perform confirmatory testing 6.