Synopsis
Choose a test that demonstrates active Helicobacter pylori infection, prepare the patient to avoid false-negative results, select eradication treatment around allergy and antibiotic exposure, and confirm cure when clinically required.
- H. pylori causes chronic active gastritis and is a major driver of duodenal and gastric ulcer, gastric adenocarcinoma and gastric MALT lymphoma.
- Use a carbon-13 urea breath test or validated stool antigen test for uncomplicated non-invasive assessment because each detects current infection rather than remote antibody exposure.
- Stop a proton-pump inhibitor for two weeks before breath or stool testing and avoid antibiotics or bismuth for four weeks where clinically safe to reduce false-negative results.
Key red flags
Dysphagia, qualifying age–weight-loss combinations, suspicious mass, progressive vomiting or unexplained iron-deficiency anaemia requires appropriate expedited investigation; a stool test must not become a gatekeeper.
Investigation priorities
Detect urease activity from current gastric H. pylori non-invasively.
Management branches
Non-invasive H. pylori testing is appropriate and no urgent endoscopic feature supersedes it.
- Check PPI, antibiotic and bismuth use, arrange a two-week PPI washout and four-week antibiotic or bismuth interval when safe, and offer temporary symptom measures that do not invalidate testing.
- Choose carbon-13 breath or validated laboratory stool antigen testing based on availability, patient preference and ability to provide a valid specimen; avoid office antibody kits.
Key medicines
First-line PPI-based H. pylori eradication combinationNICE uses seven days of a PPI twice daily plus amoxicillin 1 g twice daily and either clarithromycin or metronidazole twice daily; confirm current antibiotic strengths and selection in the local formulary.