Indications and diagnostic tests for Helicobacter pylori infection
- Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
- Professor of Medicine
- University of California, San Diego
Helicobacter pylori is the most prevalent chronic bacterial infection and is associated with peptic ulcer disease, chronic gastritis, gastric adenocarcinoma, and gastric mucosa associated lymphoid tissue (MALT) lymphoma [1-4].
This topic will review the clinical indications for testing for H. pylori, diagnostic tests for H. pylori, and their interpretation. Our recommendations are largely consistent with 2017 guidelines from the American College of Gastroenterology and the Maastricht IV consensus report [2,5]. The epidemiology, pathophysiology, and immune response to H. pylori and treatment regimens for H. pylori infection are discussed separately. (See "Pathophysiology of and immune response to Helicobacter pylori infection" and "Acute and chronic gastritis due to Helicobacter pylori" and "Association between Helicobacter pylori infection and gastrointestinal malignancy" and "Association between Helicobacter pylori infection and duodenal ulcer" and "Bacteriology and epidemiology of Helicobacter pylori infection" and "Treatment regimens for Helicobacter pylori".)
INDICATIONS FOR TESTING
Testing for H. pylori should be performed only if the clinician plans to offer treatment for positive results. Indications for testing include:
●Low grade gastric MALT lymphoma
●Active peptic ulcer disease or past history of peptic ulcer if cure of H. pylori infection has not been documented
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- INDICATIONS FOR TESTING
- APPROACH TO DIAGNOSTIC TESTING
- Medications that should be discontinued prior to testing
- Patient undergoing upper endoscopy
- Patients not undergoing upper endoscopy
- DIAGNOSTIC TESTS
- Endoscopic testing
- - Biopsy urease testing
- - Histology
- - Bacterial culture and sensitivity testing
- Noninvasive testing
- - Urea breath testing
- - Stool antigen assay
- - Serology
- - Other infrequently used tests
- CONFIRMATION OF ERADICATION
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS