Helicobacter pylori

Helicobacter pylori (H. pylori) is an organism which infects a significant proportion of the world’s population and whilst there is no doubt that it is the primary causative agent in both gastric cancer and peptic ulcer disease it is noteworthy that every mammal appears to have an H.pylori strain associated with it implying that we have a long evolutionary relationship with this organism not infection may not always be a cause of disease. Nevertheless in patients with peptic ulceration or a family history of gastric cancer or Maltoma there is no doubt the organism should be eradicated. Similarly in patients who have dyspepsia it is reasonable to undertake empirical testing using urea breath tests or the more easily undertaken faecal antigen tests. These tests should only be undertaken when patients have been off all proton pump inhibitors for two weeks and all antibiotics for 4 weeks as these can lead to false negative tests. Serological testing  is generally not recommended, either at the bedside, where the accuracy of the test is often doubtful, or following H. pylori eradication is not recommended as positive serology  often persists for months or years after successful treatment.

It is worth noting that of itself H.pylori does not cause symptoms of heartburn, acid reflux and food regurgitation, which are symptoms of gastro-oesophageal reflux disease, not peptic ulcer disease.