H. Pylori


Diagnostic Tests for Helicobacter pylori
Test Usefulness
Invasive
Endoscopy with biopsy Diagnostic strategy of choice in children with persistent or severe upper abdominal symptoms
Histology Sensitivity reduced by PPIs, antibiotics, bismuth containing compounds.
Urease activity Test of choice when endoscopy indicated; rapid results (20 min); (−) results may need confirmation by histology or other test; sensitivity reduced by PPIs, antibiotics, bismuth-containing compounds, and active bleeding.
Culture Technically demanding; only use for resistant organism or refractory disease.
Noninvasive
Check serology for immunoglobulin G Sensitivity and specificity vary widely; assist with initial diagnosis; not as helpful in following patients due to prolonged presence of antibody after eradication.
Urea breath test Reliable test for cure – can document eradication as early as 4 weeks post-treatment; requires separate appointments; sensitivity reduced by PPIs, antibiotics, and bismuth-containing compounds.
H. pylori stool antigen Detects active infection; test for cure seven days after therapy is accurate; sensitivity reduced by PPIs, antibiotics, and bismuth-containing compounds.

 

Who Should Be Tested for H. pylori?

Specific H. pylori Therapy
Treatment Dosing/Comments
PPI,
Amoxicillin 1g,
Clarithromycin 500 mg
• All BID for 7-14 days
• First line (up to date – 1A recommendation)
Bismuth 525 mg,
Metronidazole 500 mg,
Tetracycline 500 mg
• All QID with PPI BID for 7-14 days
• First line or retreatment
PPI,
Amoxicillin 1 g,
Metronidazole 500 mg
• All BID for 14 days
• First line in macrolide allergic or retreatment
PPI,
Levofloxacin 250-500 mg,
Amoxicillin 1 g
• All BID for 14 days
• Rescue for two prior treatments
PPI,
Rifabutin 150 mg,
Amoxicillin 1 g
• All BID for 14 days
• Rescue
PPI
Amoxicillin 1 g
• PPI BID, amoxicillin TID for 14 days
• Rescue