Monitoring
The patient should be re-tested after a minimum of 4 weeks after treatment. It is advisable to confirm eradication of Helicobacter pylori with a post-treatment UBT, monoclonal stool test or upper endoscopy with biopsy. Antisecretory drugs, especially PPIs should be discontinued at least 1-2 weeks prior to test, while Bismuth compounds and antibiotics should be stopped at least 4 weeks prior to the test. Patients with either gastric ulcers or complicated duodenal ulcers should have a repeat endoscopy and biopsy, UBT, or stool antigen test to rule out malignancy. In patients with persistent Helicobacter pylori infection, a culture and sensitivity may be done before retreatment, except when considering a Bismuth-based quadruple therapy. Serology is not used in determining treatment response.
Complications
In H pylori-infected patients, the risk of NSAID-related gastrointestinal (GI) complications is increased. Studies suggested that eradication of H pylori infection in patients on NSAID therapy was associated with a 57% reduction in the incidence of peptic ulcer, with the benefits greatest in NSAID-naive patients.
Please see Peptic Ulcer Disease disease management chart for further information.