Eradication of Helicobacter pylori Can Be Accurately Confirmed 14 Days after Termination of Triple Therapy Using a High-Dose Citric Acid-Based 13C Urea Breath Test

Abstract

Background: Confirmation of Helicobacter pylori eradication by urea breath test (UBT) is currently performed 4–6 weeks after completion of therapy because of unacceptable false-negative results in UBTs performed earlier. Use of a high-dose citric acid test meal appears to enable accurate detection of H. pylori even during short term therapy with proton pump inhibitors. Aim: To evaluate if use of a high dose citric acid (4.0 g) test meal can decrease the interval required for confirmation of eradication after triple therapy. Methods: 233 patients positive for H. pylori were randomized to undergo UBT at 7 days or 14 days after triple therapy, and again at 6 weeks. The latter test was considered the gold standard test. Results: The UBT performed 6 weeks after the end of treatment found that 79.9% were cured. The same test 7 days after therapy found false-negative detection of H. pylori in 7.3% patients compared to 3.2% patients examined after 14 days. The sensitivity, specificity, positive and negative predictive values and accuracy for evaluation on day 14 were 80, 100, 100, 96.3 and 96.7%, respectively. Conclusions: High-dose citric acid-based UBT is a valid test for the assessment of H. pylori status 14 days after triple therapy. This may obviate the delay in instituting second-line eradication therapy, or further evaluation of the symptomatic patient unresponsive to therapy despite eradication.

Helicobacter pylori Recurrence in Developed and Developing Countries: Meta‐Analysis of 13C‐Urea Breath Test Follow‐Up after Eradication

“…This is a noninvasive test, has no sample errors, is not radioactive, and has very high sensitivity and specificity. We previously demonstrated a very low false-negative 13 CUBT results 14 days after termination of triple therapy or when treatment with proton-pump inhibitors was sustained [24][25][26]. Endoscopy and biopsies may be considered gold standard for H. pylori diagnosis, but have never compared to 13 CUBT for the specific diagnosis of recurrence after eradication.…”

The diagnosis and management of H. pylori infection in Singapore

“…(33) As with diagnosis of H. pylori, the stool antigen test is an acceptable alternative. However, serological testing should not be used for confirmation of eradication, as the levels will remain positive.…”

Methods and functions: Breath tests

“…The urease activity is higher under acid conditions (40 times higher at pH 3.5 compared to pH 7.4) [40] which might explain the better performance of the 13 C-urea breath test using high doses of citric acid [41]. Whether high doses of citric acid enable to perform the urea breath test as therapy control already 14 days after completion of antibiotics needs to be confirmed by other studies [42].…”