Get an accurate H. pylori test – at the right time!

H. pylori – all testing methods explained

Be careful of misleading results – especially after a treatment

This can and does happen so often and so easily- especially after a course of treatment. Here are the 2 main reasons why…

1. The most commonly prescribed H. pylori blood test will show positive for traces of H. pylori, long after the bacterium has actually been treated successfully. If the results of a blood test are used after you have been on any treatment, you could end up taking a further treatment that you don’t actually need. The most frustrating thing is that thousands of people are unwittingly paying the price of this mistake every year.
2. The timing of getting retested (with the tests that are accurate) is super important. Getting tested too early when the dead bacteria has not yet left your body will almost always lead to a false positive result. To avoid this, it is important for you to know and confirm with your doctor when you are going to be retested.

3 of the 5 tests listed below that are accurate before starting a treatment, can produce completely inaccurate results when retesting after completing a treatment. This may sound illogical, but all is explained below;

Pre-Treatment Testing

The sole purpose of any H. pylori test is to detect infection or the presence of H. pylori bacteria in your stomach and the upper part of your small intestine (duodenum).

It is important to note that if you have never been treated for an H. pylori infection, then all the tests we discuss below can be relied upon for an accurate assessment of a current infection.

This reason for this is simply because it is virtually impossible to overcome an H. pylori infection without some form of treatment.

So if any of these tests reveal traces of H. pylori, then there is a very high probability of a current infection.

Post-Treatment Testing

The real problems with most of the tests listed below present themselves when you get retested after you have completed your treatment.

Keep reading, and learn why the one test that most doctors use, produces very misleading/false results – up to 2 years AFTER a successful treatment.

Misleading results may prompt your doctor into prescribing further unnecessary medication to treat what is actually now non-existent infection – that definitely does not require any further treatment.

5 different types of H. pylori tests

1. Blood antibody tests – be extra careful with these!

A blood test checks for the presence of H. pylori antibodies, not for the bacteria itself. The biggest disadvantage of this test is quite simply;

“Blood Tests cannot differentiate between a past infection and the current status of an H. pylori infection…”

Even after H. pylori has been treated, H. pylori antibodies may sometimes still be present in the blood for 12 – 18 months after successful treatment. This means that you will test positive (for antibodies) when you are actually negative after receiving treatment. In view of this, Blood Testing is considered to be the most inconclusive test that can be used to determine if a treatment has been successful or not.

DO NOT USE an H. pylori Blood Test within 18 months of your last treatment! – This is because antibodies remain in the blood for between 12 to 18 months after the H.pylori bacterium has been successfully treated. In short, this means that a Blood Test is only showing what your H. pylori status was – up to 18 months before the test.

ON THE POSITIVE SIDE – If you have NEVER been treated for H. pylori a Blood test CAN be useful! If you suspect you are infected with H. pylori, and if you have never been treated for H. pylori before, and you test positive with a Blood Test – then you are extremely likely to be infected with H. pylori. Obviously this means that you will need to start seeking effective treatment.

ALSO!! If you test negative with a blood test, you can rest assured that you are not infected with H. pylori.

2. Urea breath test

A urea breath test checks to see if you have H. pylori bacteria in your stomach. It involves using a radioactive carbon atom to detect H. pylori bacteria.

The breath test is not always available and the results are often inconsistent. This is a very expensive test, and our research has shown that this is not the best H. pylori test to go for. The inconsistency of the breath test has been proved when running a breath test concurrently with an H. pylori Stool Antigen test, or a GI-MAP stool test, on the same patient.

3. Stomach biopsy test by Endoscopy

A small sample (biopsy) is taken from the lining of your stomach and small intestine during an endoscopy. Several different tests may be done on the biopsy sample. Most biopsy tests produce inconsistent results and depend on the testing facility or laboratory used. This has been proved time and again when running biopsy tests concurrently with an HpSA test, or a GI-MAP stool test, on the same patient.

4. Stool antigen test (HpSA test)

Most commonly known as the HpSA test, this test provides conclusive evidence of the presence of H. pylori bacteria. The stool antigen test checks to see if the substances that trigger the immune system to fight an H. pylori infection (H. pylori antigens) are present in your feces (stool).

Stool antigen testing may be done to help support a diagnosis of a current H. pylori infection or to determine whether treatment for an H. pylori infection has been successful.

We recommend this test after you have been treated – it produces a simple yet very accurate result of your H. pylori status – either a positive or negative result will be given.

The HpSA test is one of the two safest and most accurate H. pylori tests. Retesting for H. pylori should be done at least 4 – 6 weeks after treatment has been completed.

5. GI-MAP Stool Test

The Gastrointestinal Microbial Assay Plus (GI-MAP™) is an innovative clinical tool that measures gastrointestinal microbiota DNA from a single stool sample with state-of-the-art, quantitative polymerase chain reaction (qPCR or real-time PCR) technology.

Like the HpSA test, it is extremely accurate, with a numerical value being given (as opposed to a simple positive or negative result).
A result of <1.0e3 (less than 1000) CFU/g means the treatment has worked and no further treatment is required. A result of >1.0e3 (greater than 1000) CFU/g means you are still infected and will require further treatment.

Getting the Results

The time taken to get results varies from test to test as follows;

• Results from the urea breath test, stool antigen (HpSA) test, and Gi-MAP test are generally available within a few hours.
• Results from a blood antibody test are usually available within 24 hours.
• Results from biopsy samples obtained by endoscopy usually available within 48 hours.
• Results from a biopsy sample that is cultured can take up to 10 days.

False positive results from retesting too early after treatment

This applies to retesting with both the HpSA and GI-MAP stools tests.

Retesting should be done 4 – 6 weeks after you have completed your treatment. Getting retested too early will lead to inaccurate test results for these 4 important reasons:

• Bacterial Clearance: It takes time for any type of H. pylori treatment to effectively clear the bacteria from your bowel and the rest of your gastrointestinal tract. The 4-6 week period allows sufficient time for all the dead bacteria to be cleared, ensuring that the test results are accurate.
• Avoiding False Positive Results: Retesting in less than 4 weeks after completion of treatment will produce false positive results in most cases, as residual bacteria or antigens may still be present in the gastrointestinal tract for up to 4 weeks – even after a successful treatment. False results are costly!
• Treatment Assessment: Waiting 4-6 weeks makes for a more accurate assessment of how effective the treatment has been, and makes it easier to see if any further or alternative treatment is required.
• Preventing Unnecessary Retreatment: Retesting too soon may result in an unnecessary retreatment. Waiting ensures that retreatment decisions are based on accurate and reliable test results.

Bibliography & References

These articles relate to Helicobacter pylori stool antigen (HpSA) testing and GI-MAP testing for the detection of h.pylori infection:

• Sánchez-Delgado, J., Calvet, X., Bujanda, L., Cosme, A., Bory, F., Recasens, M., Ponce, J. (2001). Evaluation of a new immunochromatographic test for detection of Helicobacter pylori in stool. Helicobacter, 6(3), 168-172.
• Vaira, D., Malfertheiner, P., Megraud, F., Axon, A. T., Deltenre, M., Gasbarrini, G., … & Tytgat, G. N. (2000). Diagnosis of Helicobacter pylori infection with a new non-invasive antigen-based assay. The Lancet, 356(9223), 1321-1325.
• Gisbert, J. P., de la Morena, F., & Abraira, V. (2006). Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. The American Journal of Gastroenterology, 101(4), 848-863.
• Domínguez, J., Forné, M., Boix, L., Fernández-Bañares, F., Gassull, M. A., de Torres, I., Miquel, M. (2006). Diagnosis of Helicobacter pylori infection in dyspeptic patients: a prospective and comparative study of three non-invasive tests. Helicobacter, 11(5), 282-289.
• Chey, W. D., & Wong, B. C. Y. (2007). American College of Gastroenterology guideline on the management of Helicobacter pylori infection. The American Journal of Gastroenterology, 102(8), 1808-1825.
• Chalasani, N., Oberlies, J., Boyer, J., Wilcox, C. M., & Ferguson, D. R. (1999). A prospective study of the use of a stool antigen assay to detect Helicobacter pylori infection in adults. Gastrointestinal Endoscopy, 49(2), 285-287.
• Kim, J. M., Kim, J. S., Jung, H. C., & Song, I. S. (2009). The usefulness of a rapid stool antigen test for detection of Helicobacter pylori: a prospective study. European Journal of Gastroenterology & Hepatology, 21(6), 607-610.
• Leal, Y. A., Flores, L. L., Garcia-Cortes, L. B., Cedillo-Rivera, R., & Torres, J. (2011). Antibody-based detection tests for the diagnosis of Helicobacter pylori infection in children: a meta-analysis. PLoS One, 6(5), e20130.