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

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. pylorieradication and determine clarithromycin resistance. In this prospective study, patients undergoing urea breath testing (UBT) for confirmation of H. pylorieradication were asked to collect the stool as both a dry fecal sample and fecal immunochemical test (FIT). Stool H. pyloriantigen 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. H. pylorieradication 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%. H. pyloriantigen testing on FIT stool samples to verify H. pylorieradication is feasible and has similar accuracy as H. pyloriantigen testing on dry stool samples. Dry stool, but not FIT, was suitable for non‐invasive identification of H. pyloriclarithromycin 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. pyloritreatment remains low.