Rational Testing

Diagnosis of Helicobacter pylori infection

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e828 (Published 24 February 2012)
Cite this as: BMJ 2012;344:e828

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  1. Barbara Braden, professor, consultant gastroenterologist
  1. 1Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU, UK
  1. Correspondence to: B Braden Barbara.braden{at}ouh.nhs.uk

The article explores how to test for Helicobacter pylori infection and when to check whether treatment has worked

Learning points

  • 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 …

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