From the Guidelines
Testing for cure is necessary for all H. pylori patients following treatment, including low-risk patients, as it provides an indirect measure of resistance/susceptibility in the population and confirms the success of the treatment regimen. According to the most recent and highest quality study 1, a test of cure should be performed after treatment of every patient, using a method such as the urea breath test (UBT) performed 4 or more weeks after therapy. This approach is supported by the fact that the prevalence of antibiotic resistance has increased, making it essential to confirm the effectiveness of the treatment regimen.
The study 1 emphasizes the importance of susceptibility-based therapies, which rely on either susceptibility testing or proven high local success rates. By confirming the success of the treatment regimen, clinicians can identify effective therapies and avoid those that are less effective due to antibiotic resistance. This information can be compiled and shared to distinguish locally reliable highly successful regimens from those that should be avoided.
In contrast to previous guidelines, the latest study 1 recommends testing for cure in all patients, regardless of risk level, to ensure that the treatment regimen is effective and to monitor for antibiotic resistance. This approach prioritizes the morbidity, mortality, and quality of life outcomes by ensuring that patients receive effective treatment and reducing the risk of treatment failure and complications.
Key points to consider:
- Testing for cure is necessary for all H. pylori patients following treatment, including low-risk patients.
- The urea breath test (UBT) is a recommended method for testing for cure, performed 4 or more weeks after therapy.
- Susceptibility-based therapies are essential to ensure the effectiveness of the treatment regimen.
- Confirming the success of the treatment regimen provides an indirect measure of resistance/susceptibility in the population.
From the Research
Testing for Cure in Low-Risk H. Pylori Patients
- The need to test for cure in low-risk H. Pylori patients following treatment is a topic of discussion, with various diagnostic tests available, including urea breath test (UBT), stool antigen test (SAT), and others 2, 3, 4, 5, 6.
- The accuracy of these tests can vary, with UBT generally considered to be highly accurate, while SAT may have lower specificity, particularly in post-treatment settings 3, 4.
- A study comparing the diagnostic accuracy of UBT and SAT found that UBT had a higher sensitivity and specificity than SAT in evaluating the outcome of anti-H. pylori therapy 3.
- Another study found that a new monoclonal SAT had higher sensitivity and negative predictive value than a polyclonal SAT, but still lower than UBT 4.
- The choice of test may depend on the clinical setting and the availability of resources, with UBT considered the first-line diagnostic method to monitor eradication results 3, 4.
Diagnostic Test Options
- Urea breath test (UBT): considered highly accurate, with sensitivity and specificity of 98.9% and 99.5%, respectively 4.
- Stool antigen test (SAT): may have lower specificity, particularly in post-treatment settings, with sensitivity and specificity ranging from 67% to 96% and 83% to 99%, respectively 3, 4, 5, 6.
- Other tests, such as rapid urease test, serology, and histology, may also be used, but their accuracy and reliability may vary 5.
Clinical Considerations
- The decision to test for cure in low-risk H. Pylori patients should be based on individual clinical judgment, taking into account the patient's risk factors, symptoms, and treatment response 2, 3, 4.
- The choice of diagnostic test should be based on the availability of resources, the clinical setting, and the patient's preferences 3, 4, 6.