H. pylori are one of the most common chronic bacterial infections in humans. Infection is acquired in childhood, and persists indefinitely without treatment. The prevalence in the US is 60% among Mexican Americans, 50% among African Americans and 26% among European Americans. In upper income populations, the prevalence is closer to 10%.

Virtually all infected patients develop chronic gastritis, and 10% to 15% experience recurrent gastrointestinal ulceration. Nearly half of untreated patients develop chronic atrophic gastritis and approximately 1% develop gastric adenocarcinoma or lymphoma. All patients who have active H. pylori infection should be treated.

Indications for H. pylori testing:


  • Uninvestigated dyspepsia
  • Duodenal or Gastric ulcer (past or current)
  • Atrophic gastritis
  • Gastric malignancy
  • To evaluate the success of eradication therapy

Strongly recommended

  • Chronic NSAID, aspirin or antisecretory drug therapy
  • Relatives of patients with H. pylori infection or peptic ulcer
  • Non-ulcer dyspepsia

Testing for H. pylori was previously done by serology, but this is no longer recommended because of its low sensitivity and inability to confirm eradication after therapy. Post therapy confirmatory testing is critical because 30% of patients fail to clear the organism after initial triple therapy. These patients require further evaluation and treatment.

The American Gastroenterological Association’s position statement on the evaluation of dyspepsia states that “H. pylori testing is optimally performed by a C-urea breath test or stool antigen test”. The higher cost of these tests is offset by their accuracy. The C-urea breath method is the only test that is FDA approved for both diagnostic and post treatment testing.

To avoid false negative results, post-treatment testing should be delayed until 4 weeks after completion of the drug regimen. If the stool antigen test is used, a 6 to 12 week waiting period is necessary.

The C-urea breath test is simple to perform and uses a balloon collection device. The patient first provides a baseline sample, and then drinks a citrus flavored, non-radioactive C-urea solution. 15 minutes later, a second breath sample is collected.

Patient preparation

  • Patients should discontinue PPI’s (includes Prilosec®, Prevacid®, Aciphex®, Nexium®), antibiotics and preparations containing bismuth (Pepto-Bismol®), two weeks before diagnostic testing, and four weeks before post treatment testing.
  • H2 antagonists may be substituted for PPIs. These medications do not affect test results and include Zantac®, Tabamet®, Pepsid®, and Axid®.
  • Patients should be NPO for 1 hour before the test is done (no food, liquids, or smoking).

COMMENTS: Patient Prep: Patient is to be fasting for 1 hour prior to the test, no food, liquids or smoking; abstain from the following medications for 2 weeks prior to the test: all antibiotics, Proton Pump Inhibitors (Prilosec®, Prilosec OTC®, Prevacid®, Aciphex®, Protonix® and Nexium®), generic version of PPIs and Bismuth Preparations such as Pepto Bismol®. Can use Zantac®, Tagamet®, Pepsid® and Axid®.