Helicobacter Pylori Eradication Confirmation by Urea Breath Test MCQ — NEET PG Practice Question | NEETPGAI
Helicobacter Pylori Eradication Confirmation by Urea Breath Test
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stethoscope Medicine
A 52-year-old man with a history of peptic ulcer disease completed a 14-day course of bismuth quadruple therapy for Helicobacter pylori eradication 4 weeks ago. He is currently on omeprazole 20 mg daily for symptom control. He now presents for confirmation of eradication. The testing protocol marked **B** in the diagram represents the CORRECT approach for eradication confirmation. Which of the following is the MOST appropriate next step in his management?
A. Perform urea breath test with 13C urea after holding omeprazole for 2 weeks
B. Perform repeat endoscopy with rapid urease test and biopsy
C. Perform serology (IgG antibodies) to confirm eradication
Perform urea breath test immediately without holding proton pump inhibitor
D.
Explanation
Why "Perform urea breath test with 13C urea after holding omeprazole for 2 weeks" is right
The structure marked B in the diagram specifies "Test 4 weeks post-treatment with PPI held 2 weeks," which is the gold-standard protocol for H. pylori eradication confirmation per Maastricht VI/Florence Consensus 2022 and ACG Guidelines 2024. The patient has already waited 4 weeks post-antibiotics. Holding the PPI (omeprazole) for ≥2 weeks before testing is essential because PPIs suppress bacterial urease activity and cause organisms to shift to the fundus, leading to false-negative results. The 13C urea breath test is the first-line non-invasive test for eradication confirmation, with sensitivity 88-95% and specificity 95-100%, and is safe in all populations (non-radioactive). After holding the PPI for 2 weeks and performing the UBT, successful eradication can be reliably confirmed.
Why each distractor is wrong
Perform serology (IgG antibodies) to confirm eradication: Serology (IgG) remains positive for months to years after successful eradication and cannot distinguish active from past infection. Serology is only useful for initial diagnosis in high-prevalence settings, never for post-treatment confirmation. This is explicitly contraindicated per Maastricht VI guidelines.
Perform urea breath test immediately without holding proton pump inhibitor: While the timing of 4 weeks post-treatment is correct, performing the UBT while the patient is still on omeprazole will suppress H. pylori urease activity and cause false-negative results. The mandatory 2-week PPI washout period (as specified in B) must be observed to ensure test accuracy.
Perform repeat endoscopy with rapid urease test and biopsy: Invasive testing with endoscopy and rapid urease test is only indicated when endoscopy is needed for another clinical reason (e.g., non-healing ulcer, MALT lymphoma assessment, complications). For routine eradication confirmation in an asymptomatic patient, non-invasive testing (UBT or stool antigen) is preferred and more cost-effective.
High-YieldNEET PG
Always confirm H. pylori eradication with UBT or stool antigen 4 weeks after antibiotics with PPI held ≥2 weeks; serology is never appropriate for post-treatment confirmation.
Maastricht VI/Florence Consensus 2022; ACG H. pylori Guidelines 2024
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