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JCOM Abstract

J Clin Outcomes Manage 
2012 Apr;19(4):158-166
Helicobacter pylori infection: who and how to test?
Saad RJ

Abstract Objective: To review the evidence and current recommendations regarding screening indications and testing methodology for Helicobacter pylori infection. Methods: Review of the literature. Results: Absolute indications for H. pylori screening include active peptic ulcer disease, confirmed history of peptic ulcer disease, gastric mucosal associated lymphoid tissue (MALT) lymphoma, and following endoscopic resection of early gastric cancer. Other clinical conditions warranting screening include uninvestigated dyspepsia, iron deficiency anemia, and primary immune thrombocytopenia. Clinical conditions in which H. pylori testing should be considered on a case-by-case basis include functional dyspepsia, chronic nonsteroidal anti-inflammatory drug/aspirin use, chronic proton pump inhibitor use, and those with a strong family history of gastric cancer. H. pylori screening is not indicated in the evaluation of gastroesophageal reflux disease. Endoscopic-based testing methods include rapid urea test, histology, culture, and polymerase chain reaction. Noninvasive test modalities include the urea breath test, fecal antigen test, and H. pylori antibody tests. Accuracy of testing can be impaired by the use of antibiotics, antisecretory drug therapy, bismuth-based compounds, or with active gastrointestinal bleeding. The positive predictive value of H. pylori antibody testing is highly dependent upon the prevalence of H. pylori and should not be the sole method of testing in populations with a low prevalence. Conclusions: H. pylori remains a common chronic infection with a worldwide prevalence. Although H. pylori can remain clinically silent, it has been linked with peptic ulcer disease and gastric malignancy and associated with dyspepsia, iron deficiency anemia, and primary immune thrombocytopenia. Given these potential complications of H. pylori infection, it is important to understand the appropriate clinical conditions to screen for H. pylori and the most accurate testing methodology to identify infection

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