From the Guidelines
The best test for H. pylori is the urea breath test (UBT), which is also the recommended test for patients who have had H. pylori before. For initial diagnosis, other reliable options include stool antigen testing and endoscopic biopsy with rapid urease testing or histology. The UBT is preferred for confirming eradication or detecting recurrence because of its high sensitivity (95%) and specificity (95-100%) 1.
To ensure accurate results, patients should stop proton pump inhibitors (PPIs) for 2 weeks before testing, and antibiotics for 4 weeks. The UBT works by detecting the presence of urease, an enzyme produced by H. pylori that breaks down urea into carbon dioxide and ammonia. During the test, patients ingest labeled urea, and if H. pylori is present, the labeled carbon dioxide can be detected in the breath. Post-treatment testing to confirm eradication should be performed at least 4 weeks after completing therapy.
Some key points to consider when choosing a test for H. pylori include:
- The UBT is the most accurate non-invasive test for H. pylori infection 1
- Stool antigen testing is a good alternative to the UBT, with similar accuracy 1
- Serological tests are not recommended for routine use, due to variability in accuracy and the potential for false positives 1
- Endoscopic biopsy with rapid urease testing or histology can be used for initial diagnosis, but is more invasive than the UBT or stool antigen testing 1
Overall, the UBT is the best test for H. pylori, due to its high accuracy and non-invasive nature. For patients who cannot tolerate the UBT, the stool antigen test is a good alternative.
From the Research
Best Test for H pylori
- The best non-invasive tests for diagnosis of H. pylori infection include the urea breath test (UBT) and stool antigen testing 2.
- UBT is a highly sensitive and specific test that allows for the diagnosis of the presence or absence of H. pylori infection 3.
- There are two types of UBTs available: 13C-UBT and 14C-UBT, with 13C-UBT being the preferred diagnostic approach due to its non-radioactive nature and higher accuracy 4.
Recommended Test for a Patient Who Has Had H. pylori Before
- For patients who have had H. pylori before, UBT is recommended for re-examining after eradication therapy 4.
- The 13C-UBT is preferred over the 14C-UBT due to its higher accuracy and non-radioactive nature 4.
- It is essential to note that proton pump inhibitor therapy can lead to false-negative H. pylori test results, and treatment should be stopped for 1-2 weeks prior to testing if possible 2, 5.
- Antacids do not impair the sensitivity of the breath tests or the stool test, making them a suitable alternative for patients who need to continue taking antacids 5.