Diagnosis of Helicobacter pylori infection
(Published 24 February 2012)
Cite this as: BMJ 2012;344:e828
- Barbara Braden, professor, consultant gastroenterologist
- 1Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU, UK
- Correspondence to: B Braden
The 13C urea breath test or the stool antigen test can be used for non-invasive screening for Helicobacter pylori in a “test and treat strategy” in younger patients presenting with dyspepsia without alarm symptoms
As proton pump inhibitors, antibiotics, and acute bleeding might cause false negative results (except in serological testing), stop proton pump inhibitors at least two weeks, and antibiotics four weeks, before testing; if gastrointestinal haemorrhage is present and tests are negative, consider serological testing or waiting four to eight weeks after the bleeding event and doing a non-invasive test (breath test or stool antigen test) then
The 13C urea breath test and the stool antigen test are reliable and accurate for testing whether the treatment has worked
A 32 year old nurse presents with intermittent discomfort in her upper abdomen for more than five months, particularly when fasting. She denies any weight loss, recurrent vomiting, dysphagia, fever, or a change in bowel habits. There is no evidence of gastrointestinal bleeding. She takes no medications, including over the counter non-steroidal anti-inflammatory drugs. She does not smoke and drinks about 4 units of alcohol a week. Abdominal examination shows mild epigastric tenderness.
What is the next investigation?
Dyspepsia in patients younger than 55 years presenting without alarm symptoms does not require endoscopic investigation.1 Empirical treatment with a proton pump inhibitor or the “test and treat” strategy for Helicobacter pylori infection are recommended management strategies in this setting and are equally cost effective in relation to symptom control.2 H pylori infection is usually acquired during childhood, and the prevalence is high (70-90%) in Asia, Africa, South America, and eastern Europe and low in western Europe and North America (30%).3 Testing for the …