The use of non‐invasive stool tests for verification of Helicobacter pylori eradication and clarithromycin resistance

• Published in: United European gastroenterology journal Vol. 11; no. 9; pp. 894 - 903
• Main Authors: Mommersteeg, Michiel C., Nieuwenburg, Stella A. V., Wolters, Leonieke M. M., Roovers, Buddy H. C. M., van Vuuren, Hanneke A. J., Verhaar, Auke P., Bruno, Marco J., Kuipers, Ernst J., Peppelenbosch, Maikel P., Spaander, Manon C. W., Fuhler, Gwenny M.
• Format: Journal Article
• Language: English
• Published: Nijmegen John Wiley & Sons, Inc 01.11.2023; John Wiley and Sons Inc
• Subjects: Antibiotics; Antigens; Breath tests; Cancer therapies; Drug resistance; Feces; Gastric cancer; Infections; Medical screening; Mutation; Neurogastroenterology; Original; Patients; Netherlands; Europe
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1002/ueg2.12473

Abstract Background Clarithromycin resistance of Helicobacter pylori ( H. pylori ) represents a major challenge in eradication therapy. In this study, we assessed if non‐invasive stool tests can be used to verify successful H. pylori eradication and determine clarithromycin resistance. Materials and methods In this prospective study, patients undergoing urea breath testing (UBT) for confirmation of H. pylori eradication were asked to collect the stool as both a dry fecal sample and fecal immunochemical test (FIT). Stool H. pylori antigen testing (SAT) was performed on these samples and assessed for its accuracy in eradication verification. Type and duration of antibiotic treatment were retrospectively collected from patient records and compared with clarithromycin resistance determined by PCR of stool samples. Results H. pylori eradication information was available for a total of 145 patients (42.7% male, median age: 51.2). Successful eradication was achieved in 68.1% of patients. SAT on FIT samples had similar accuracy for eradication assessment compared to dry fecal samples, 72.1% [95% CI 61.4–81.2] versus 72.2% [95% CI 60.9–81.7]. Clarithromycin resistance rate was 13.4%. Conclusion H. pylori antigen testing on FIT stool samples to verify H. pylori eradication is feasible and has similar accuracy as H. pylori antigen testing on dry stool samples. Dry stool, but not FIT, was suitable for non‐invasive identification of H. pylori clarithromycin resistance by rt‐PCR personalizing antibiotic treatment strategies without the need for invasive diagnostics is desirable, as the cure rate of first‐line empirical H. pylori treatment remains low.