The non-invasive tests that can be used for the test and treat strategy are UBT and the stool antigen tests. Certain kits for serology with high accuracy can also be applied | | 1a | B |
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PPI is a source of false negative diagnostic tests except serology. PPIs should be stopped for at least 2 weeks before performing a diagnostic test | | 1b | A |
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Serology should be considered as a diagnostic test when other diagnostic tests might be false negative, such as in patients with bleeding ulcers, gastric atrophy, MALT lymphoma, and recent or current use of PPIs and antibiotics | | 2 | B |
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The serological tests are not all equivalent and different tests may be applied in different situations | | 2b | B |
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The detection of specific H pylori antibodies in urine and saliva has no current role in patient management but can he helpful for epidemiological studies | | 1b | A |
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Serology based near doctor-patient tests have no current role in the management of H pylori infection | | 1 | A |
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Detection of H pylori pathogenic factors and the study of host genetic polymorphisms is not helpful in the management of H pylori infection | | 3b | D |
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It is recommended that a follow-up evaluation to confirm successful eradication be performed after H pylori eradication with UBT if available. If not available a laboratory based stool test, preferably using monoclonal antibodies, could be used | | 1b | A |
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Culture and antimicrobial sensitivity testing should be routinely performed: | | | |
Before clarithromycin based treatment, if primary resistance to clarithromycin is greater than 15–20% in the respective area | | | |
After two treatment failures with different antibiotics | | 1b | B |
Monitoring of primary antibiotic resistance should be carried out in reference laboratories in different areas: | | | |
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In patients presenting for endoscopy without pretreatment, a positive rapid urease test is sufficient to initiate treatment | | 2 | A |