Overview of indications for H. pylori testing and eradication therapy

Testing for and eradicating Helicobacter pylori infection may confer benefit by:

  • reducing upper gastrointestinal tract symptoms—all people with H. pylori infection develop active chronic gastritis, but most are asymptomatic
  • treating active H. pylori-associated peptic ulcer disease—H. pylori infection confers a lifetime risk of 15 to 20%
  • reducing the risk of upper gastrointestinal bleeding
  • reducing the risk of gastric cancer—H. pylori infection confers a lifetime risk of up to 2%.

The decision to test for and treat H. pylori should be individualised. The indications for eradication therapy from consensus guidelines are summarised in Indications for Helicobacter pylori testing and eradication therapy.

Eradication therapy should be offered to patients found to be infected with H. pylori. However, eradicating H. pylori is not appropriate in some patients; consider the patient’s goals of care, potential adverse effects of eradication therapy, and whether eradication will significantly improve the patient’s quality of life.

Table 1. Indications for Helicobacter pylori testing and eradication therapyFock, 2009

Clinical situation

Benefits of eradication therapy

Testing for H. pylori is indicated

peptic ulcer disease (past or present)

heals ulcers and reduces relapse

dyspepsia

may reduce symptoms and long-term risks of peptic ulcer disease and gastric cancer

atrophic gastritis and intestinal metaplasia

reduces long-term risk of gastric cancer

first-degree relatives of patients with gastric cancer

reduces long-term risk of gastric cancer

patients already treated for early gastric cancer

reduces risk of further gastric cancer

low-grade gastric MALT lymphoma

induces regression of lymphoma

at patient’s request, after discussing possible harms and benefits

fulfils patient’s desire to reduce risk of transmitting H. pylori infection

Testing for H. pylori may be indicated

strategy for gastric cancer prevention in communities with high incidence of gastric cancer

not relevant in Australia in general, but may be useful in high-risk patients (see H. pylori and gastric cancer)

selected users of an NSAID (including aspirin)

reduces risks of peptic ulcer disease and gastric bleeding

patients requiring long-term acid suppression

reduces progression of intestinal metaplasia

Note:

MALT = mucosa-associated lymphoid tissue; NSAID = nonsteroidal anti-inflammatory drug