Confirming Helicobacter pylori eradication after treatment

What it is

After treatment for H. pylori, eradication has to be confirmed by a test. Follow-up noninvasive testing to confirm HP eradication should be performed at least 4 weeks after completion of therapy, in any patient with a positive H. pylori test result. The stance is now broad: all H. pylori-infected individuals should be treated regardless of symptoms, given the link to gastric cancer.

How it is diagnosed

The methods split into invasive and non-invasive:

• Invasive, at EGD: rapid urease test (RUT, the CLO test), sensitivity 75-98% with specificity 70-98%; culture, sensitivity 70-92% with specificity 100%; histology, sensitivity 93-99% with specificity 95-99%
• Non-invasive: stool antigen test (SAT), sensitivity 89-96% with specificity 87-94%; serology (ELISA), sensitivity 88-99% with specificity 86-99%; 13C-urea breath test, sensitivity 95% and specificity 95-99%

Culture is marked as the golden best test, but not practical. Usually go for a non-invasive test if there is no indication for EGD. High risk goes invasive; a young and asymptomatic patient at low risk goes non-invasive. When you test is part of the test. Check at least 4 weeks after completion of therapy, and before testing stop the PPI for 2 weeks and the antibiotic for 4-6 weeks.