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When is retesting for H pylori indicated?

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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.

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