Helicobacter pylori

Diagnosis of H. pylori infection

• All patients with symptoms related to the upper gastrointestinal tract should be tested for H. pylori.
• Non-invasive testing is recommended in situations where there is a low risk of the patient having gastric cancer, such as those up to 45 years and without alarm symptoms (such as weight loss, dysphagia, overt gastrointestinal bleeding, abdominal mass or iron-deficient anaemia).
• Non-invasive tests include:
  • Urea breath test (UBT): recommended non-invasive test of choice, where available
  • Faecal antigen testing: less sensitive than UBT but with high specificity. Can be performed if UBT not available.
  • H. pylori serology: less sensitive and specific. Perform only if UBT or faecal antigen testing is unavailable.
• For patients over 45 years or with alarm symptoms, endoscopy is recommended.
• PPIs should be avoided two weeks before any testing is performed as they may increase the risk of a false negative result.
• Antimicrobials should also be avoided for four weeks before testing.

Treatment

Post eradication testing

• Must be performed at least eight weeks following completion of therapy.
• If gastroscopy is not required, a urea breath test is recommended.
• The stool antigen test may be used as an alternative, but is less accurate.
• Serology testing is not recommended for eradication confirmation as antibodies may persist for months following eradication.

Failure of first line regimen

• In cases where first line regimen has failed to eradicate infection, a different treatment regimen should be used as second line.
• Post-eradication testing is recommended (as above).
• If the patient cannot take a second line regimen due to e.g. allergy consider referral to gastroenterology service for endoscopy with culture and antimicrobial susceptibility testing to tailor therapy.

Failure of second line regimen

• Refer to gastroenterology service for endoscopy with culture and antimicrobial susceptibility testing to tailor therapy and increase the likelihood of eradication success.

Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Clarithromycin and other macrolides warning
• Fluoroquinolone warning
• Penicillin allergy – tips on prescribing in penicillin allergy
• Renal impairment dosing table
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed January 2021

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