H pylori Antibody Titer

Harley R. Liker, MD, MBA

Disclosures

December 09, 2003

Question

How does H pylori antibody titer relate to likelihood of current or past infection in cases of gastritis or peptic ulcer disease?

Response from Harley R. Liker, MD, MBA

Helicobacter pylori antibody titers are useful in helping to determine whether an individual has been exposed to H pylori over the course of his or her lifetime. The best tests available to determine whether an individual has an active infection with H pylori include (1) H pylori stool antigen, (2) urea breath test, or (3) a CLO test done at the time of upper endoscopy.

Thus, a negative H pylori antibody titer is helpful in that it indicates that the patient has not had prior exposure to Helicobacter pylori over the course of his or her lifetime. However, a positive titer does not help determine whether an individual has an active infection. In some cases, patients who have had a positive H pylori antibody titer can have a decrease in their titer over time. However, in general, once patients are positive serologically they will remain positive for the rest of their lives. It should also be noted that once H pylori has been eradicated with the use of antibiotics and proton-pump inhibitors, the H pylori serology is likely to remain positive. If one wanted to document eradication of H pylori, the testing of choice would include a urea breath test or possibly a stool antigen. When used to document eradication of H pylori, those tests are best done 2-3 months after the patient has completed therapy. Finally, it is worth noting that a recent paper published in Alimentary Pharmacologic Therapeutics in September 2003[1] suggested that some patients may have a decrease in their antibody titer several months after H pylori eradication.

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