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欧洲幽门螺杆菌治疗共识 5

Breath test as double check

Breath tests are the most accurate way of detecting H.pylori without actually having an endoscopy (stomach examination). Breath tests are especially useful after treatment to make sure H.pylori is cured. Urea breath tests are known to be completely harmless. Either C14-urea or C13-urea tests are used. Read about them at the diagnosis section at where a diagram can be found. C14-urea breath tests use a radioactive tracer but such a tiny amount that it can be used safely at any age. It is a 15 minute test, convenient and inexpensive. The C13-urea test uses a stable isotope of carbon which is also harmless but requires two breath samples and takes about 30 minutes. Both tests have accuracy greater than 90%.

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Joined: Tue Sep 04, 2018 2:20 am

Breath test as double check

Post by toblerone » Tue Sep 04, 2018 1:42 pm


I was diagnosed with H. pylori and would like to ask if an additional breath test would be advised to confirm it before I start taking drugs (since some sources say serology alone is not reliable enough).

Profile: Irregularly and infrequently (6-8 months between incidents) recurring mild, easy to ignore and confusable with hunger, dyspepsia in the upper part of the stomach. Started ~6 years ago; last time was about 4 months ago. Seems to be correlated with stress level, but hard to establish a causal relationship with such a low frequency. An incident usually lasts for 0.5-2 days. No belching or reflux symptoms. Originally I'm from a country with H. pylori prevalence of 60-75% (varies by source), and had never been taking antibiotics nor NSAIDs (nor almost any other drug). No history of peptic disease in family. Male, 39 years old, vegetarian (last 5 years), BMI 21.3.

Tests: Blood test showed IgG>8.0 units/ml (the reference range was given as "<0.9 negative, 0.9-1.1 undecided, >1.1 positive"). Endoscopy found two white-colored ulcerous defects on the duodenal bulb (0.5-0.6 cm on it's rear side, and a fibrin-covered one of 0.4 cm on the front side). No biopsy during the endoscopy was made. Also, the endoscopist wrote "reflux-esophagitis?" after observing isolated white-coloured inflammations <0.2cm in the lower third of esophagus. The same blood test showed some other values outside their normal ranges: direct bilirubin 5.7 micromole/litre (range: 0-5.5 micromole/litre), alkaline phosphatase 100 units/mole (25-90 units/mole), hematocrit 50.9% (30.5-50.5%).

I wonder if I need a breath test to double check for H. pylori or this evidence is enough to start treatment?

By the way, I'm interested also if you find the prescribed drugs and the regime reasonable in my case:
from Day 1:
Pantoprazole: two times per day for 14 days, then once per day for another 14 days // 30 min before meal
Clarithromycin: 2 times/day with a 12-hour interval, for 10 days
Amoxicilin: 2 times/day, for 10 days
Saccharomyces Boulardii: 2 times/day, for 10 days // after meal

from Day 12:
Bismuth Subcitrate: 2 times/day 20 min, for 14 days // before meal
Ursodeoxycholic Acid: once in the evening, for 20 days

4 weeks after treatment:
Stool test

Thank you in advance!

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Re: Breath test as double check

Post by Helico_expert » Wed Sep 05, 2018 10:13 pm

The treatment plan sounds ok. something novel that I have not seen. I wonder why cant the doctor add bismuth from day 1.

anyway, if you had not taken any antibiotics after the blood test, then there is no need for you to do breath test to confirm it.

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Re: Breath test as double check

Post by toblerone » Thu Sep 06, 2018 2:09 am

Thank you! Yes, was wondering too about that 1-day gap inserted between 10 days of antibiotics and bismuth on the 12th day. So you think it's fine to follow the treatment as prescribed, or I should worry about the gap and try to get explanations from the doctor?

Does it help (or at least does not hurt) to support the treatment with foods like broccoli sprouts and milk fermented with L. acidophilus and B. bifidus? Something else that might inhibit H. pylori or reduce side effects?

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Re: Breath test as double check

Post by Helico_expert » Thu Sep 06, 2018 9:12 am

your doctor must have good experience from such treatment to prescribe you such treatment strategy. So go for it.

there is no guideline to what to take to reduce side effect. you can take anything you want that you think helpful.

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