when is testing for H. pylori indicated?

Last edited 03/2019 and last reviewed 06/2021

Indications for H pylori testing:

• patients with uncomplicated dyspepsia unresponsive to lifestyle change and antacids, following a single one month course of proton pump inhibitor (PPI), without alarm symptoms
  • Note:
    • options should be discussed with patients, as the prevalence of HP in developed countries is falling, and is lower than 15% in many areas in the UK.
    • a trial of PPI should usually be prescribed before testing, unless the likelihood of HP is 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 HP first, or in parallel with a course of PPI
      
      
• patients with a history of gastric or duodenal ulcer/bleed who have not previously been tested
  
  
• patients before taking NSAIDs, if they have a prior history of gastro-duodenal ulcers/bleeds. Note: Both HP and NSAIDs are independent risk factors for peptic ulcers, so eradication will not remove all risk
  
  
• patients with unexplained iron-deficiency anaemia, after negative endoscopic investigation has excluded gastric and colonic malignancy, and investigations have been carried out for other causes, including: cancer; idiopathic thrombocytopenic purpura; vitamin B12 deficiency

When H pylori testing is not indicated:

• patients with proven oesophagitis, or predominant symptoms of reflux, suggesting gastro-oesophageal reflux disease (GORD)
• children with functional dyspepsia

Reference:

• PHE (February 2019). Test and treat for Helicobacter pylori (HP) in dyspepsia.