when is retesting for H pylori indicated?

Last edited 03/2019 and last reviewed 06/2021

When is retesting for H pylori indicated?

• if compliance poor, or high local resistance rates
  
  
• persistent symptoms, and HP test performed within two weeks of taking PPI, or within four weeks of taking antibiotics
  
  
• patients with an associated peptic ulcer, after resection of an early gastric carcinoma or MALT lymphoma
  
  
• patients requiring aspirin, where PPI is not co-prescribed
  
  
• patients with severe persistent or recurrent symptoms, particularly if not typical of GORD

If retesting:

• UBT (urea breath test) is most accurate
• SAT (stool antigen test) is an alternative

Wait at least four weeks (ideally eight weeks) after treatment. If acid suppression needed use H2 antagonist.

Use second-line treatment if UBT or SAT remains positive

Management if eradication failure:

• reassess need for eradication
  
  
• in patients with GORD or non-ulcer dyspepsia, with no family history of cancer or peptic ulcer disease, a maintenance PPI may be appropriate

Indications for referral for endoscopy, culture and sensitivity testing:

• patients in whom the choice of antibiotic is reduced due to hypersensitivity, known local high resistance rates, or previous use of clarithromycin, metronidazole, and a quinolone
  
  
• patients who have received two courses of antibiotic treatment, and remain HP positive
  
  
• for any advice, speak to your local microbiologist, or the Helicobacter Reference Laboratory

Reference:

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