Login
Search

Search
Search
  1. Home
  2. Category
  3. Gastrointestinal including Liver
  4. Helicobacter Pylori Infection

Helicobacter Pylori Infection

NICE Clinical guideline [CG184] Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Last updated: Oct 2019. BNF Treatment summaries. Helicobacter pylori infection.

Guidelines

BNF recommends any of the following:

  • Urea 13C breath test (↑ 13C is indicative of H. pylori infection)
  • Stool antigen test
  • Laboratory-based serology

 

Urea 13C breath test and stool antigen test should be delayed if the patient:

  • Takes PPI → delay until after 2 weeks of not taking it (wash out period)
  • Take antibiotics → delay until after 4 weeks of not taking them

H. pylori eradication uses a triple-therapy regimen (1 PPIProton pump inhibitor and 2 antibiotics)

 

The following sections have been simplified for education purposes, the author deems that BNF and NICE included excessive detail that is unlikely to be examined or encountered in clinical practice.

1st line: 7 days of
  • PPIProton pump inhibitor, and
  • Amoxicillin, and
  • Clarithromycin or metronidazole

2nd line (1st line not effective) 7 days of
  • Switch the 3rd antibiotic (clarithromycin or metronidazole) into whichever was not used
  • If still ineffective → PPIProton pump inhibitor + amoxicillin + tetracycline (alternative: levofloxacin)

If still not effective → seek specialist advice

1st line: 7 days of
  • PPIProton pump inhibitor, and
  • Clarithromycin, and
  • Metronidazole

Do not routinely offer re-testing after H. pylori eradication therapy
 

Consider re-testing if:

  • Poor compliance to eradication therapy
  • Initial test was performed within 2 weeks of PPIProton pump inhibitor or 4 weeks of antibiotic
  • Aspirin or NSAID is indicated, esp. if there is a history of peptic ulcer disease
  • Family history of gastric malignancy
  • Severe / persistent / recurrent symptoms
  • Person requests re-testing

Retesting should be performed at least 4 weeks (ideally 8 weeks) after initial eradication therapy


Test of choice:
  • 1st line: urea 13 C breath test
  • 2nd line: stool antigen test

 

Before performing a urea 13 C breath test or stool antigen test make sure that the patient has not taken a PPIProton pump inhibitor in the past 2 weeks, or antibiotics in the past 4 weeks.

If patients require treatment in between those times → use histamine2-receptor antagonists before testing (instead of PPIProton pump inhibitor)

References

Author: Adams Lau
Reviewer:
Last edited: 05/08/25