Assessing the outcome of H. pylori eradication therapy in adults

Assess the outcome of Helicobacter pylori eradication therapy in all cases of complicated ulcer disease, or if considering cessation of maintenance therapy for peptic ulcer disease. Assessment is also recommended in other situations because it guides subsequent management, provides reassurance when negative, and can have medicolegal implications. It also provides valuable data on the rate of successful H. pylori eradication in practice, which is known to be lower than rates reported in clinical trials.

Post-treatment testing is best done with a C¹³- or C¹⁴-urea breath test (see Diagnostic tests for H. pylori). Antibiotic therapy and bismuth should not be taken for at least 4 weeks, and PPI therapy should be withheld for at least 1 week (and preferably 2 weeks) before breath testing, to minimise the chance of false-negative results. Treatment with H₂-receptor antagonists can continue as they do not have this effect.

Serology is not reliable in assessing the outcome of eradication therapy because antibodies may still be detected years after successful eradication.

Follow-up endoscopy (and biopsy) is usually not required, except for gastric ulcers (to exclude malignancy and assess healing) and for some complicated duodenal ulcers (eg ulcers first presenting with bleeding).