Background: 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. pylori eradication and determine clarithromycin resistance.

Materials and methods: In this prospective study, patients undergoing urea breath testing (UBT) for confirmation of H. pylori eradication were asked to collect the stool as both a dry fecal sample and fecal immunochemical test (FIT). Stool H. pylori antigen 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.

Results: H. pylori eradication 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%.

Conclusion: H. pylori antigen testing on FIT stool samples to verify H. pylori eradication is feasible and has similar accuracy as H. pylori antigen testing on dry stool samples. Dry stool, but not FIT, was suitable for non-invasive identification of H. pylori clarithromycin 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. pylori treatment remains low.

MCM declares that he has no conflicts of interest. SAVN declares that she has no conflict of interest. LMMW declares that she has no conflict of interest. BHCMR declares that she has no conflict of interest. AJV declares that she has no conflicts of interest. APV declares that she has no conflict of interest. MPP declares that he has no conflicts of interest. GMF declares that she has no conflict of interest. MJB has received research grants from Boston Scientific, grants and personal fees from Cook Medical, grants from Pentax Medical, grants from 3M, grants from Mylan, and grants from InterScope, outside the submitted work. EJK declares that he has no conflict of interest. MCWS has received grants from sysmex, sentinel, Medtronic, Boston Scientific, Norgine, outside the submitted work. The authors have no potential conflicts of interest to disclose that are relevant to this manuscript. Full disclosures have been submitted to the journal.