To diagnose an infection with Helicobacter pylori (H. pylori), the bacteria that can cause peptic ulcers; to determine whether treatment has cured the infection
When you have symptoms of an ulcer, such as ongoing indigestion, gastrointestinal pain that comes and goes, unexplained weight loss, nausea and/or vomiting; about 4-6 weeks after completing treatment for the infection
A stool sample, a breath sample, or a tissue biopsy of the stomach lining
You may need to avoid certain medications; follow any instructions you are given.
Helicobacter pylori is a type of bacteria that is known to be a major cause of peptic ulcers. H. pylori testing detects an infection of the digestive tract caused by the bacteria to help diagnose the cause of symptoms and/or ulcers.
H. pylori infections of the digestive tract are very common, with as many as half of the world's population infected. However, most people with H. pylori never have any symptoms. Still, H. pylori infection increases the risk of developing ulcers (peptic ulcer disease), persistent stomach inflammation (gastritis), and gastric (stomach) cancer. The bacteria decrease the stomach's ability to produce mucus, making the stomach prone to damage from digestive acid and peptic ulcers.
A few different types of H. pylori testing are available, such as a stool antigen test and a breath test. Some are less invasive than others. See the "How is the test used?" section under Common Questions for details.
How is the sample collected for testing?
The sample collected depends on the test ordered:
A more invasive test will require a procedure called an endoscopy, which involves putting a thin tube with a tiny camera on the end down the throat into the stomach. This allows your healthcare practitioner to view the stomach lining and take a small piece of tissue (a biopsy) from the lining for examination.
Is any test preparation needed to ensure the quality of the sample?
For the breath test, you may be instructed to refrain from taking certain medications:
If submitting a stool sample or having a tissue biopsy collected, it may be necessary to refrain from taking any antibiotics, antacids, or bismuth treatments for 14 days prior to the test.
If undergoing endoscopy, fasting, usually overnight, may be required. Only water may be permitted.
H. pylori testing is used to detect the bacteria in the digestive tract, diagnose the infection, and to evaluate whether treatment has cured the infection.
There are several different types of H. pylori testing that can be performed. The following tables summarize these tests:
|Stool/fecal antigen test||Detects the presence of H. pylori antigen in a stool sample|
|Urea breath test||
|Histology||Tissue examined under a microscope by a pathologist, who will look for H. pylori bacteria and any other signs of disease that may explain a person's symptoms.|
|Rapid urease testing||H. pylori produces urease, an enzyme that allows it to survive in the acidic environment of the stomach. The laboratory test can detect urease in the tissue sample.|
|Culture||The bacteria are grown on/in a nutrient media; results can take several weeks. This test is necessary if the healthcare practitioner wants to evaluate which antibiotic will likely cure the infection. (See also Antibiotic Susceptibility Testing.)|
|PCR (polymerase chain reaction)||Fragments of H. pylori DNA are amplified and used to detect the bacteria; primarily used in a research setting.|
The stool antigen test and urea breath test are recommended for the diagnosis of an H. pylori infection and for the evaluation of the effectiveness of treatment. These tests are the most frequently performed because they are fast and noninvasive. (The urea breath test is not typically recommended for young children. In children, the preferred test would be the stool antigen test.) Endoscopy-related tests may also be performed to diagnose and evaluate H. pylori but are less frequently performed because they are invasive.
The testing recommendations come from guidelines by the American Gastroenterology Association (AGA), the American College of Gastroenterologists (ACG), and the Infectious Diseases Society of America (IDSA) / the American Society for Microbiology (ASM).
Testing may be ordered when you have pain in your digestive tract and other signs and symptoms of an ulcer. Examples include:
Some people may have more serious signs and symptoms that require immediate medical attention, including sharp, sudden, persistent stomach pain, bloody or black stools, or bloody vomit or vomit that looks like coffee grounds.
H. pylori testing may also be ordered about 4 to 6 weeks after you have finished taking the prescribed antibiotics to confirm that the infection is cured. A follow-up test is not performed on every person, however.
A positive H. pylori stool antigen, breath test, or biopsy indicates that your signs and symptoms are likely caused by a peptic ulcer due to these bacteria. Treatment with a combination of antibiotics and other medications will be prescribed to kill the bacteria and stop the pain and the ulceration.
A negative test result means that it is unlikely that you have an H. pylori infection and your signs and symptoms may be due to another cause. However, if symptoms persist, additional testing may be done, including the more invasive tissue biopsy, to more conclusively rule out infection.
People can have digestive tract pain for many reasons; an ulcer caused by H. pylori is only one of them.
If you use antacids within the week prior to testing, the rapid urease test may be falsely negative. Antimicrobials, proton pump inhibitors, and bismuth preparations may interfere with test results.
Treatment usually involves a combination of antibiotics and drugs to reduce the amount of stomach acid produced, such as proton pump inhibitors and histamine receptor blockers, as well as a bismuth preparation, such as Pepto-Bismol®, taken for several weeks.
No, many people have evidence of infection but have no symptoms of ulcerative disease. The reason why some people with H. pylori infections develop peptic ulcers and others do not is not yet understood.
Since the infection is very common and most people do not ever get ulcers, testing is generally only recommended for those who have signs and symptoms.
The bacteria are believed to be transmitted by eating food or drinking water that has been contaminated with human stool, or possibly through contact with the stool, vomit, or saliva of an infected person. Exposure to family members with H. pylori seems to be the most likely opportunity for transmission.
The majority of people who successfully complete the combination antibiotic therapy get rid of these bacteria from their digestive tract. However, resistance to some of the antibiotics may occur and, therefore, the bacteria may continue to multiply despite appropriate therapy.
Treatment does not make a person immune, so there is always the potential for becoming infected again.
The American Gastroenterology Association, the American College of Gastroenterologists, the Infectious Diseases Society of America and the American Society for Microbiology do not recommend the antibody blood test for routine use in diagnosing an H. pylori infection or evaluating its treatment as the test cannot distinguish between a present and previous infection. A few healthcare practitioners still order this test, but many laboratories have stopped offering it. If performed and the blood test is negative, then it is unlikely that the person has had an H. pylori infection. If it is positive, then the presence of a current H. pylori infection should be confirmed with a stool antigen or breath test.
Sources Used in Current Review
Santacroce, L. and Bhutani, M. (2018 August 9, Updated). Helicobacter Pylori Infection. Medscape Gastroenterology. Available online at https://emedicine.medscape.com/article/176938-overview. Accessed on 9/08/18.
Lai, S. (2017 August 1, Updated). Tests for H. pylori. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/007501.htm. Accessed on 9/08/18.
Couturier, M. and Jarboe, E. (2018 August, Updated). Helicobacter pylori. ARUP Consult. Available online at https://arupconsult.com/content/helicobacter-pylori. Accessed on 9/08/18.
Zingman, B. et. al. (2017 October 12, Updated). Helicobacter pylori infection. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/007715.htm. Accessed on 9/08/18.
(© 1995– 2018). Helicobacter pylori Breath Test. Mayo Clinic Mayo Medical Laboratories. Available online at https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81590. Accessed on 9/08/18.
(© 1995– 2018). Helicobacter pylori Antigen, Feces. Mayo Clinic Mayo Medical Laboratories. Available online at https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81806. Accessed on 9/08/18.
Sultan, M. et. al. (2018 February 12, Updated). Pediatric Helicobacter Pylori Infection. Medscape Pediatrics: General Medicine. Available online at https://emedicine.medscape.com/article/929452-overview. Accessed on 9/08/18.
(April 5, 2017) Armand W. H. pylori, a true stomach "bug": Who should doctors test and treat? Harvard Health. Available online at https://www.health.harvard.edu/blog/h-pylori-a-true-stomach-bug-who-should-doctors-test-and-treat-2017040511328. Accessed Sep 2018.
(© 1995–2018). Helicobacter pylori Diagnostic Algorithm. Mayo Clinic Mayo Medical Laboratories. Available online at https://www.mayocliniclabs.com/it-mmfiles/Helicobacter_pylori_Diagnostic_Algorithm.pdf. Accessed Sep 2018.
© 2018 ARUP Laboratories. Helicobacter pylori Breath Test. Available online at https://www.aruplab.com/testing/0020646. Accessed Sep 2018.
Sources Used in Previous Reviews
The Cleveland Clinic Health Information Center. Breath Test for H. pylori (Online information). Available online at http://www.clevelandclinic.org/health/. Accessed February 2008.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006.
Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott's Diagnostic Microbiology 12th Edition: Mosby Elsevier, St. Louis, MO; 2007.
Chisholm SA, Owen RJ. Application of polymerase chain reaction-based assays for rapid identification and antibiotic resistance screening of Helicobacter pylori in gastric biopsies. Diagn Microbiol Infect Dis. 2008 Jan 11.
Siddique I, et. al Diagnosis of Helicobacter pylori: Improving the Sensitivity of CLOtest by Increasing the Number of Gastric Antral Biopsies. J Clin Gastroenterol. 2008 Apr;42(4):356-360.
Clinical Chemistry: Principles, Procedures, Correlations. Bishop M, Duben-Engelkirk J, Fody E, eds. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
Clinical Chemistry: Theory, Analysis, and Correlations. Kaplan L, Pesce A, eds. 2nd ed. St. Louis: The C. V. Mosby Company; 1989.
National Digestive Diseases Information Clearinghouse. H. pylori and Peptic Ulcer. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/. Accessed June 2011.
Michael Selgrad, Arne Kandulski and Peter Malfertheiner. Helicobacter pylori: Diagnosis and Treatment: Diagnosis of Helicobacter pylori. Curr Opin Gastroenterol. 2009;25(6):549-556. Available online at http://www.medscape.com/viewarticle/711405_2. Accessed June 2011.
Baumann, A. and Katz, P. (Updated 2014 January 27). Helicobacter Pylori Antigen Test. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2117821-overview. Accessed October 2014.
Santacroce, L. and Bhutani, M. (Updated 2014 September 11). Helicobacter Pylori Infection. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/176938-overview. Accessed October 2014.
Longstreth, G.(Updated 2013 August 22). Tests for H pylori. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/007501.htm. Accessed October 2014.
DiMarino, M. (Revised 2014 May). Helicobacter pylori Infection. The Merck Manual Professional Edition [On-line information]. Available online through http://www.merckmanuals.com. Accessed October 2014.
(© 1995–2014). Helicobacter pylori Antibody, IgA, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/35755. Accessed October 2014.
(2013 November). Helicobacter pylori Infection: Test Utilization Strategies for Diagnosis. Communique, Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/articles/communique/2013/11-hpylori-infection/. Accessed October 2014.
Kelly, J. (2014 September 30). WHO Urges H pylori Screening to Prevent Gastric Cancer. Medscape News [On-line information]. Available online at http://www.medscape.com/viewarticle/832581. Accessed October 2014.
Baron, E. et. al. (2013 July 10). A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). [On-line information]. Available online through http://www.idsociety.org. Accessed October 2014.
Pagana, K. D., Pagana, T. J., and Pagana, T. N. (© 2015). Mosby's Diagnostic & Laboratory Test Reference 12th Edition: Mosby, Inc., Saint Louis, MO. Pp 494-496.