From the Guidelines
Confirmatory testing for Helicobacter pylori (H. pylori) eradication is indicated after treatment in certain situations.
Indications for Confirmatory Testing
- In cases of complicated peptic ulcer disease, gastric ulcer, or low-grade gastric MALT lymphoma, confirmatory testing is necessary to ensure eradication of H. pylori 1.
- After treatment for gastric ulcer, histological examination should also be performed to exclude malignancy 1.
- In areas with low H. pylori infection, a test-and-treat strategy should be considered, and confirmatory testing can be used to determine the success of eradication treatment 1.
Timing of Confirmatory Testing
- The time for testing the success of H. pylori eradication after the end of treatment should be at least 4 weeks 1.
- However, some studies suggest that the proposed period of 4 weeks may be questioned, and proposals have been made to extend it to 6 or 8 weeks 1.
Methods of Confirmatory Testing
- The UBT or a laboratory-based validated monoclonal stool test are both recommended as non-invasive tests for determining the success of eradication treatment 1.
- In special cases, endoscopy-based testing with biopsy specimens from the antrum and body may be necessary 1.
- Serology should not be used to assess early success or failure of therapy due to its limitations 1.
From the Research
Confirmatory Testing for H. pylori Eradication
- Confirmatory testing for H. pylori eradication is indicated after treatment, as symptoms may not be an accurate indicator of treatment success 2, 3, 4, 5, 6.
- 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 2.
- Other recommended tests for confirmation of H. pylori eradication include the urea breath test, biopsy-based test, and stool antigen test 3, 5.
- Testing should be performed at least 4 weeks after treatment 3, 6.
- Serology with pre and 6 months post treatment samples is usually not recommended except in specific cases, such as H. pylori eradication campaigns in populations at high risk for stomach cancer 3.
Patient Preferences and Symptom Status
- Patients' desire to know whether their infection has been cured and symptom status after treatment are important determinants of whether confirmatory H. pylori testing should be undertaken routinely 6.
- A study found that 90% of patients preferred to undergo confirmatory testing if asymptomatic, and were willing to pay more than $50 for it 6.
- However, symptom status after treatment may not be a reliable indicator of treatment success, as 38% of patients in whom H. pylori was eradicated reported that their symptoms were completely resolved, while 28% of patients who were still infected reported complete symptom resolution 6.