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When is testing for H pylori indicated?

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

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