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"UBT (Urea Breath Test) advantages include: Identifies active H. pylori infection. Excellent PPV and NPV regardless of H. pylori prevalence. Useful before and after H. pylori therapy…"
"….though a negative antibody test suggests the absence of infection, a positive test is no better than a coin toss in predicting the presence of active infection".
"As such, in low prevalence populations, antibody tests should be avoided altogether or positive results should be confirmed with a test that identifies active infection such as the UBT or FAT prior to initiating eradication therapy…"
" A ’test-and-treat‘ strategy is recommended for most patients with undifferentiated dyspepsia. With this approach, patients undergo a noninvasive test for H. pylori infection and, if positive, are treated with eradication therapy. This strategy reduces the need for anti-secretory medications as well as the number of endoscopies. The urea breath test or stool antigen test is recommended."
"Cost-effectiveness studies suggest that the choice of a noninvasive test should be based on the prevalence of infection in the community. In low- and intermediate prevalence situations, the stool antigen test or the urea breath test dominate. The higher cost of these tests is offset by their accuracy."
"The diagnostic accuracy of the UBT is >95% in studies. The UBT is an accurate, practical, and readily available test. Serology is a widely available and inexpensive non-invasive test, but the diagnostic accuracy is low."
“Serology based office tests have no current role in the management of H pylori infection.”