Do You Need a Repeat H. Pylori Test After Treatment?

Breath test (carbon isotope-urea breath test)

Proton pump inhibitors (PPIs), Pepto-Bismol, and antibiotics must be stopped 2 weeks before the test.

During the test, you will be asked to swallow a urea-containing material. Your body produces urea as a waste product when it breaks down protein.

Carbon dioxide in your exhaled breath can be detected and recorded after 10 minutes if H pylori are present because the bacteria convert urea to carbon dioxide. The breath test can detect almost all H. pylori infections and confirm whether the infection has been successfully treated.

Blood tests

Blood tests measure H. pylori antibody levels. When your immune system recognizes and responds to harmful bacteria, it produces antibodies. 

Blood work for the infection can only detect the presence of H. pylori antibodies. It cannot indicate how long you have had it because positive test results can persist for several years after treating the virus.

Stool test

A stool polymerase chain reaction (PCR) test can detect H pylori infection in your stool.

It can be performed to detect the infection and determine whether it has been treated successfully by looking for H. pylori traces in stools.

Biopsy

During an endoscopy, a tissue sample or biopsy from the stomach lining is collected. This test is the most reliable way to determine if you are infected with H. pylori.

A biopsy is typically performed when endoscopy is required for another reason, such as to diagnose an ulcer, stop bleeding, or check for cancer.

Most people with H. pylori infection never present with any symptoms, although the reason for this is unclear. Some people may be born with a higher resistance to the harmful effects of the infection.

When H pylori infection does cause signs or symptoms, they are often related to gastritis or a peptic ulcer and may include:

• Upper abdominal pain
• Feeling full after eating a small amount of food
• Nausea
• Vomiting
• Belching (burping)
• Bloating
• Loss of appetite

Advanced signs and symptoms of stomach ulcers include:

• Severe abdominal pain
• Dark or black-colored stools
• Ulcers that bleed can cause a low blood count (anemia)
• Fatigue
• Unusual weight loss
• Shortness of breath

H. pylori bacteria can infect the stomach through the following:

• Saliva
• Vomit
• Stool
• Contaminated water or food

Complications of H. pylori infection include

• Ulcers: H. pylori can damage the lining of the stomach and small intestine. Because of this, stomach acids can cause an open wound (ulcer). Most H pylori carriers (about 10%) will develop ulcers.
• Stomach lining inflammation: H. pylori infection can irritate and inflame the stomach (gastritis).
• Stomach cancer: Certain kinds of stomach cancer are strongly associated with H. pylori infection.

The typical treatment for H pylori infection is a 14-day course of drugs, such as:

• Dexilant (dexlansoprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Protonix (pantoprazole)
• Aciphex (rabeprazole)
• Nexium (esomeprazole)

Treatment approaches include the following:

• Proton pump inhibitors (PPIs) are used to reduce the production of stomach acid. To lower the chance of treatment failure and antibiotic resistance, two antibiotics are typically advised in addition to a PPI.
• Bismuth quadruple therapy involves using bismuth subsalicylate, metronidazole, tetracycline, and a PPI for 14 days.
• Clarithromycin triple therapy involves the administration of a PPI, amoxicillin, and clarithromycin twice daily for 14 days.
• Clarithromycin, amoxicillin, nitroimidazole (tinidazole or metronidazole), and a PPI are given concurrently for 10-14 days as concomitant therapy.
• Hybrid treatment is 7 days of amoxicillin and a PPI, then 7 days of amoxicillin, clarithromycin, nitroimidazole, and a PPI.
• Levofloxacin triple therapy lasts 10-14 days and consists of levofloxacin, amoxicillin, and a PPI.
• Levofloxacin sequential therapy involves taking amoxicillin and a PPI for 5-7 days and then, levofloxacin, amoxicillin, nitroimidazole, and a PPI for 5-7 days.
• Levofloxacin quadruple therapy involves the administration of levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD) for 7-10 days (additional studies are needed to confirm the efficacy of this regimen and its cost-effectiveness).
• Do not use Pepto-Bismol or other antibiotics 4 weeks before your test (oral bismuth subsalicylate).

When your laboratory test results become available, your healthcare provider will contact you.

If your test results show that you have the H. pylori infection, you will be prescribed antibiotic treatment. Your doctor may want a follow-up breath test after one month of antibiotic therapy to ensure the infection has been successfully treated.

If a test is negative but you still experience symptoms, your doctor may request additional tests to identify the source of the problem.