Recommendations for testing for H pylori infection following treatment (Part 1)

Serology is not an acceptable follow-up test because antibodies may remain detectable for over 12 months despite successful cure of the infection . If UBT is not available, endoscopy with biopsies may be performed to document cure if the endoscopy is clinically indicated. Should the patient continue to be H pylori-positive, retreatment with an alternative eradication therapy is recommended.

In Canada, the success rate of H pylori eradication treatment is high (75% to 85%) and, therefore, it is likely that, once treated, patients will become H pylori-negative. Acid suppressive therapy is the treatment of choice for ongoing symptoms, and it is reasonable to start this treatment as soon as the patient returns for management of symptoms rather than awaiting the results of further H pylori testing.

It is recognized that PPIs suppress H pylori, although cure of the infection with PPI monotherapy is very rare . Up to 20% of patients may test falsely negative for the infection if PPIs are used at the time that a UBT is performed . The recommendation is to stop PPIs for 14 days before the UBT . In practice, this may be difficult because some patients will have worsening of symptoms during this interval. Often this can be bridged with the use of antacids. For ^RAs, the recommendation is to stop for seven days before testing because they too can have an effect on H pylori . In practice, it may be reasonable to use two weeks as a guideline for all such medications. Antimicrobials and bismuth compounds must be discontinued for four weeks before a UBT to avoid false-negative test results. If your health problem is affecting the quality of your life, you should consider shopping for your medications with that will help you make sure the right treatment is found, not costing too much money.

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