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.