Best Test for Confirmation of H. pylori Eradication
The 13C-urea breath test (UBT) performed at least 4 weeks after completion of therapy is the best test for confirming cure of H. pylori infection due to its high accuracy and non-invasive nature. 1
Recommended Non-Invasive Tests for H. pylori Eradication Confirmation
Urea Breath Test (UBT)
- UBT using [13C]urea remains the gold standard for post-treatment confirmation with high sensitivity (94%) and specificity (100%) when performed at least 4 weeks after completion of therapy 1, 2
- Must be performed at least 4 weeks after completion of therapy to avoid false-negative results caused by temporary suppression of infection 3
- Proton pump inhibitors should be discontinued at least 2 weeks before testing to avoid false-negative results 1
Stool Antigen Test (SAT)
- Laboratory-based monoclonal antibody SAT has comparable accuracy to UBT for post-treatment diagnosis with sensitivity of 94% and specificity of 97% 1, 4
- Only validated laboratory-based monoclonal tests should be used, not rapid in-office immunochromatographic tests which have limited accuracy 1
- Like UBT, should be performed at least 4 weeks after completion of therapy 4
Important Testing Considerations
Timing of Testing
- Testing should be performed at least 4 weeks after completion of eradication therapy 1
- Some evidence suggests that testing at 3 months may be preferable to minimize false-positive results compared to testing at 1 month 2
- Early testing (7 days after treatment) with stool antigen test may identify treatment failures but should not replace formal testing at 4+ weeks 4
Medication Interference
- PPIs should be discontinued for 2 weeks before testing by UBT or SAT to avoid false-negative results 1
- Antimicrobial agents can also decrease bacterial load and lead to false-negative results 1
- If PPIs cannot be stopped, validated IgG serology can be used, though this is not ideal for post-treatment evaluation 1
Tests to Avoid for Post-Treatment Evaluation
- Serology is not suitable for post-treatment evaluation within 6-12 months of therapy as antibodies remain elevated for months to years after successful eradication 1, 3
- Rapid in-office stool tests have limited accuracy and should not be used 1
Test of Cure as Antimicrobial Stewardship
- Test of cure results provide valuable indirect assessment of local antimicrobial resistance patterns 1
- Collecting and sharing test of cure data can help identify effective and ineffective treatment regimens in a community 1
- This information should be incorporated into local antimicrobial stewardship programs to guide future treatment decisions 1
Special Situations
- In patients with bleeding ulcers or other conditions that may reduce bacterial load, UBT is recommended to rule out false-negative biopsy test results 5
- For patients with atrophic gastritis or gastric malignancies where bacterial load may be low, validated IgG serology may be considered, though not ideal for post-treatment evaluation 1