Post-treatment Follow-Up testing

[mhambley92]

Is it always a good idea to get a follow up test once the treatment (in my case a 7 day "Hp-pac" that includes a morning and evening dose of prevacid 30mg, biaxin 500mg, and amoxicillin 500mg) is completed? Are urea breath tests, stool samples, and endoscopy samples the only three legitimate ways to confirm eradication? Which is the most reliable? What are the risks involved with doing the less reliable two? How soon after I finish the hp-pac should I get a follow up test? I live 6 hours away from the closest lab that offers these tests, is it okay to wait until my next scheduled trip to the city, which will be just over 6 weeks after I finish the 7 day treatment course, until I get the follow up test? What are risks with waiting too long for a follow up? What are the benefits of doing it right on recommended time?

[Helico_expert]

because the standard therapy has such a good cure rate of 80%, many doctors actually did not request for a follow up breath test. However, the cure rate has dropped significantly in Europe countries and so, depending which region you are from, if your region has high antibiotic resistance, then you should go for a confirmation test. other wise, it's ok not to do it.

In addition, if you are in the high risk group where you are more likely to get ulcer or even cancer, then I would highly recommend you to get it check, and make sure it's gone forever.

In terms of the accuracy, all three tests (breath, stool and endoscopy) have good sensitivity and specificity. I reckon breath test as it is the easiest. But some people are afraid of the C14 radiation. Then again, you can go for the C13 breath test if it is available.

stool test is as accurate and probably cheaper, but not many people likes to deal with stools.

endoscopy is the most accurate and the most expensive.

there is also blood test, but it's not suitable for your case because blood test is testing for the antibody in your blood. Your immune cells are very clever in memorising the pathogen and so you'll have antibody against H. pylori for months or even years. Which also mean, blood test will always be positive for the next few months or years.

To get a confirmation test, we normally ask patients to wait 4 weeks. That will give enough time for the survival H. pylori to build up mass to be detected (avoid false negative).

anything that will reduce the bacterial load or acidity will affect the test results. for example probiotics and PPI. So, depending on which PPI you are taking, we normally will ask patients to stop PPI for at least 2 weeks before the confirmation test.