Eradication of Helicobacter Pylori Can Be Accurately Confirmed 14 Days After Termination of Triple Therapy Using a High-Dose Citric Acid-Based 13C Urea Breath Test

Digestion. 2005;71(4):208-12. doi: 10.1159/000087045. Epub 2005 Jul 12.


Background: Confirmation of Helicobacter pylori eradication by urea breath test (UBT) is currently performed 4-6 weeks after completion of therapy because of unacceptable false-negative results in UBTs performed earlier. Use of a high-dose citric acid test meal appears to enable accurate detection of H. pylori even during short term therapy with proton pump inhibitors.

Aim: To evaluate if use of a high dose citric acid (4.0 g) test meal can decrease the interval required for confirmation of eradication after triple therapy.

Methods: 233 patients positive for H. pylori were randomized to undergo UBT at 7 days or 14 days after triple therapy, and again at 6 weeks. The latter test was considered the gold standard test.

Results: The UBT performed 6 weeks after the end of treatment found that 79.9% were cured. The same test 7 days after therapy found false-negative detection of H. pylori in 7.3% patients compared to 3.2% patients examined after 14 days. The sensitivity, specificity, positive and negative predictive values and accuracy for evaluation on day 14 were 80, 100, 100, 96.3 and 96.7%, respectively.

Conclusions: High-dose citric acid-based UBT is a valid test for the assessment of H. pylori status 14 days after triple therapy. This may obviate the delay in instituting second-line eradication therapy, or further evaluation of the symptomatic patient unresponsive to therapy despite eradication.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bismuth / therapeutic use
  • Breath Tests / methods*
  • Carbon Isotopes
  • Citric Acid*
  • Drug Therapy, Combination
  • Female
  • Helicobacter Infections / diagnosis*
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Humans
  • Male
  • Middle Aged
  • Organometallic Compounds / therapeutic use
  • Predictive Value of Tests
  • Salicylates / therapeutic use
  • Sensitivity and Specificity
  • Treatment Outcome
  • Urea*


  • Anti-Bacterial Agents
  • Carbon Isotopes
  • Organometallic Compounds
  • Salicylates
  • Citric Acid
  • bismuth subsalicylate
  • Urea
  • Bismuth