Follow-up examinations after treatment are crucial, as only through re-examination can it be confirmed whether the treatment has achieved the desired effect. If the treatment is unsuccessful, a new treatment plan can be developed in a timely manner.
So, when should one follow up for Helicobacter pylori infection? It is recommended to wait at least 4 weeks after completing treatment before follow-up to avoid potential interference of the treatment medication with test results. When undergoing follow-up, make sure you haven’t used any antimicrobial or bismuth agents in the last 4 weeks, or any acid-suppressing medications such as PPIs and H2 blockers in the last 2 weeks.
What tests should be done at the time of follow-up? Usually, we prefer the carbon-13 or carbon-14 breath test to determine if eradication treatment was successful. In special circumstances, follow the doctor’s advice and choose the appropriate test. For example, for those with gastric ulcers, due to the risk of potential malignancy with this condition, regardless of the success of H. pylori eradication treatment, a gastroscopy should be performed again and both the gastric ulcers and H. pylori should be tested.
The following criteria can be used to determine if H. pylori has been eradicated:
- A negative result in the carbon-13 or carbon-14 breath test.
- A negative result for H. pylori antibody in the blood test (however, it should be noted that blood tests are not the preferred method for assessing treatment effect, as antibodies can remain positive even after successful treatment).
- Negative results from gastric mucosa biopsies taken from the antrum and the body of the stomach during an endoscopy.
What if treatment fails? For patients whose first-line standard therapy has failed, doctors will recommend rescue therapy or other alternative options. If a patient has a history of using metronidazole or clarithromycin, these drugs should be avoided in subsequent treatments. If possible, a drug sensitivity test could be performed before treatment to choose the most effective medication. There is no clear evidence that delayed treatment improves outcomes, so rescue therapy does not need to wait for any specific duration.
