Role of seroconversion in confirming cure of Helicobacter pylori infection

JAMA. 1998 Jul;280(4):363-5. doi: 10.1001/jama.280.4.363.


Context: The role of serologic testing to confirm cure of Helicobacter pylori infection after antimicrobial therapy is not completely defined.

Objective: To determine the utility of serologic testing in confirming cure of H pylori infection more than 1 year after therapy.

Design: A prospective, before-after interventional trial.

Setting: An outpatient clinical research laboratory in an academic, urban Veterans Affairs medical center.

Participants: Twenty-three otherwise healthy men and women with active H pylori infection demonstrated by gastric biopsy and with positive H pylori serologic findings.

Intervention: A 14-day course of bismuth, tetracycline, and metronidazole.

Main outcome measures: Determination of IgG serum antibodies to H pylori at baseline, 1 month, 3 months, and approximately 18 months after completion of therapy compared with serial gastric mucosal biopsy specimens with stains for H pylori and for histologic examination as the criterion standard.

Results: Fifteen (65%) of 23 subjects were cured of their H pylori infection as assessed by gastric biopsy, with elimination of gastritis; median antibody levels declined from 92.5 U/mL at baseline to undetectable levels at 18 months. The other 8 subjects (35%) were not cured and had persistent gastritis at 18 months; median antibody levels declined from 130.6 U/mL at baseline to 89.7 U/mL at 18 months. Sensitivity and specificity of seroconversion (from a positive to negative test result) in detecting cure of H pylori infection were 60% and 100%, respectively.

Conclusion: Undetectable antibody levels beyond the first year of therapy accurately confirm cure of H pylori infection in initially seropositive healthy subjects, with reasonable sensitivity.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Antacids / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Bacterial / analysis*
  • Biopsy
  • Bismuth / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Gastritis / drug therapy*
  • Gastritis / microbiology*
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / immunology*
  • Helicobacter pylori / immunology*
  • Humans
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Serologic Tests
  • Tetracycline / therapeutic use


  • Antacids
  • Anti-Bacterial Agents
  • Antibodies, Bacterial
  • Metronidazole
  • Tetracycline
  • Bismuth