A 42-year-old man completed first-line triple therapy for Helicobacter pylori gastritis four weeks ago. He is still taking esomeprazole 20 mg daily for reflux symptoms. Which test is most appropriate to document eradication at this visit?
- A Urea breath test performed off the proton pump inhibitor for at least two weeks ✓
- B Rapid urease test on antral biopsy
- C Serum anti-Helicobacter pylori IgG antibody titre
- D Antral biopsy for histology alone
Correct answer: A. Urea breath test performed off the proton pump inhibitor for at least two weeks
Explanation
Confirmation of eradication should be done at least four weeks after therapy using a urea breath test or stool antigen test. Proton pump inhibitors suppress bacterial load and urease activity, causing false negatives, so they must be stopped for about two weeks before testing. Serology remains positive for years after cure and cannot distinguish active from past infection, so it is useless for documenting eradication.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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