Helicobacter pylori (H. pylori) is a bacterium colonising the gastric mucosa and may be the causative agent in several gastrointestinal conditions including peptic ulcer disease and gastric adenocarcinoma.
N.B. Patients with isolated gastro-oesophageal reflux do not need routine testing for H. pylori.
*If alarm symptoms are present or patient is ≥55 years old, consider referral for urgent upper gastrointestinal endoscopy to exclude malignancy.
N.B. Ensure that PPI is stopped at least two weeks before C13 urea breath testing and stool antigen testing to prevent false negative results.
All patients with proven H. pylori infection should be offered eradication. Consider testing for successful eradication if persistent symptoms or in the case of proven peptic ulcers (the C13 urea breath test is first-line).
One week of therapy with a proton pump inhibitor (PPI) and two antibiotics is recommended.
Standard regimen, prescribe:
In penicillin allergic patients, prescribe:
Patients should be counselled on the importance of compliance before starting treatment and in those patients taking metronidazole on the avoidance of alcohol because of the risk of a disulfiram-like reaction.
After one week of treatment all medication can be stopped, except where ulcers have bled or perforated, when a PPI may be continued.
N.B. Healing of gastric ulcers must be confirmed by endoscopy after 6 – 8 weeks.
Guideline reviewed: May 2023
Page last updated: December 2023