Helicobacter pylori: test and treat in primary care

This is uncomplicated dyspepsia in a young woman. There are no alarm features: no weight loss, vomiting, dysphagia, bleeding, anaemia or mass, and she is under 55. In this group Australian guidance uses a 'test and treat' approach: test non-invasively for H. pylori and treat if positive, without endoscopy [VERIFY].

The urea breath test is the preferred non-invasive test in Therapeutic Guidelines (Gastrointestinal) and Gastroenterological Society of Australia advice [VERIFY]. It has sensitivity and specificity above 95% and detects active infection only. The patient must stop proton pump inhibitors for 2 weeks and antibiotics for 4 weeks before the test, because these suppress the organism and cause false negatives.

The faecal antigen test is an acceptable alternative with similar accuracy when the breath test is not available, and has the same drug-withholding rules.

Serology is not recommended. It stays positive for years after the infection is gone, so it cannot distinguish current from past infection and cannot be used to confirm eradication.

If the test is positive, first-line treatment in Australia is a proton pump inhibitor with amoxicillin and clarithromycin for 7 to 14 days [VERIFY], followed by a repeat breath test at least 4 weeks after finishing antibiotics to confirm eradication.