H pylo ri testing and eradication for adults
• Patients with uncomplicated dyspepsia u nresponsive to lifestyle change and antacids, following a single one month course of proton pump i nhibitor (PPI),
without alarm symptoms. A trial of PPI should usu ally be prescribe d before testing, unless the likelihood of HP is likely to be higher than 20% (older
people, people of North African ethnicity, those living in a known high risk area); in which case the patient should have a test for H. pylori first, or in
parallel with a course of PPI.
• Patients with a history of gastric or duodenal ulcer or bleed, if they have not previously been tested.
• Before starting or taking NSAIDs, if there is a history of gastro-duodenal ulcers or bleeds. Note that HP a nd NSAIDs are independent risk factors for
peptic ulcers, so eradication will not remove all risk.
• Patients with un explained iron-deficiency anaemia, after negati ve endoscopic investigation has excluded gastric and colonic malig nancy, and
investigations have been carried out for other causes, includi ng: cancer, idiopathic thrombocytopenic purpura, vitamin B12 deficiency.
• Before stool antigen testing for H pylori, patients should have stopped bismuth or PPI for at least 2 weeks; antibi otics for 4 weeks; and H2 Receptor
Antago nist (H2RA) at least 1 day before, or results may be unreliable
• Patients with proven oesophagitis, or predominant symptoms of reflux, suggesting GORD (gastro-oesophageal r eflux disease)
When should I treat Helicobacter pylo ri?
H pylori Positive
H pylori Negative
ASYMPTOMATIC post-HP
treatment
Treat H pylori
If H pylori negative treat as functional dyspepsia.
Step down to lowest dose of PPI or H2RA nee ded
to control symptoms. Review annually, including
PPI need.
Reassure, as
negative
pre dictive val ue
(NPV) of all tests
is >95%
Only retest f or HP if DU, GU,
family history of cancer,
MALToma or if test was
performed within two weeks of
PPI or four weeks of antibiotics
When should I test for Helicoba cter pylori (HP)?
When is a test for Helicobacter pylori not required?
Approved by AMG July 2019
Review d ate July 2022
