Diagnosis

Several tests and procedures are used to determine whether you have an H. pylori infection. Testing is important for detection of H. pylori but also to test after treatment to be sure it has been eliminated.

  • Stool tests. The most common stool test to detect H. pylori is called a stool antigen test that looks for foreign proteins (antigens) associated with H. pylori infection in your stool. Antibiotics, acid-suppressing drugs known as proton pump inhibitors (PPIs) and bismuth subsalicylate (Pepto-Bismol) can interfere with the accuracy of these tests. If you were previously diagnosed with and treated for H. pylori, your doctor will generally wait at least four weeks after you complete your antibiotic treatment to test your stool. If you are taking a PPI, your doctor will ask you to stop taking PPI medications for one or two weeks before the test. This test is available for adults and children older than 3.

    A laboratory test called a stool polymerase chain reaction (PCR) test can detect H. pylori infection in your stool and mutations that may be resistant to antibiotics used to treat it. This test is more expensive and may not be available at all medical centers. This test is available for adults and children.

  • Breath test. During a breath test, you swallow a pill, liquid or pudding that contains tagged carbon molecules. If you have an H. pylori infection, carbon is released when the solution is broken down in your stomach.

    Your body absorbs the carbon and expels it when you exhale. You exhale into a bag, and your doctor uses a special device to detect the carbon molecules.

    As with stool tests, PPIs, bismuth subsalicylate (Pepto-Bismol) and antibiotics can interfere with the accuracy of this test. If you are taking a PPI, your doctor will ask you to stop taking the PPI medications for one or two weeks before the test. If you were previously diagnosed with and treated for H. pylori, your doctor will generally wait at least four weeks after you complete your antibiotic treatment to perform the breath test. This test is available for adults and children.

  • Scope test. You'll be sedated for this test, known as an upper endoscopy exam. During the exam, your doctor threads a long flexible tube equipped with a tiny camera (endoscope) down your throat and esophagus and into your stomach and duodenum. This instrument allows your doctor to view any irregularities in your upper digestive tract and remove tissue samples (biopsy). These samples are analyzed for H. pylori infection.

    This test is done to investigate symptoms that may be caused by other conditions such as gastric ulcer or gastritis that may be due to H. pylori. The test may be repeated after treatment depending on what is found at the first endoscopy or if symptoms persist after H. pylori treatment. At this second exam, biopsies can be performed to make sure H. pylori has been eliminated. If you were previously diagnosed with and treated for H. pylori, your doctor will generally wait at least four weeks after you complete your antibiotic treatment to perform the breath test. If you are taking a PPI, your doctor will ask you to stop taking the PPI medications for one or two weeks before the test.

    This test isn't always recommended solely to diagnose an H. pylori infection because it's more invasive than a breath or stool test. But it may be used to perform detailed testing for doctors to determine exactly which antibiotic to prescribe to treat H. pylori, especially if antibiotics fail or to rule out other digestive conditions.

More Information

Treatment

H. pylori infections are usually treated with at least two different antibiotics at once, to help prevent the bacteria from developing a resistance to one particular antibiotic. Your doctor also will prescribe or recommend an acid-suppressing drug, to help your stomach lining heal.

Drugs that can suppress acid include:

  • Proton pump inhibitors (PPIs). These drugs stop acid from being produced in the stomach. Some examples of PPIs are omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix).
  • Histamine (H-2) blockers. These medications block a substance called histamine, which triggers acid production. One example is cimetidine (Tagamet HB).
  • Bismuth subsalicylate. More commonly known by the brand name Pepto-Bismol, this drug works by coating the ulcer and protecting it from stomach acid.

Your doctor may recommend that you undergo testing for H. pylori at least four weeks after your treatment. If the tests show the treatment was unsuccessful, you may undergo another round of treatment with a different combination of antibiotic medications.

Preparing for your appointment

See your primary care doctor if you have signs or symptoms that indicate a complication of H. pylori infection. Your doctor may test and treat you for H. pylori infection, or refer you to a specialist who treats diseases of the digestive system (gastroenterologist).

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Before your appointment, you might want to write a list that answers the following questions:

  • When did your symptoms begin?
  • Does anything make them better or worse?
  • Have your parents or siblings ever experienced similar problems?
  • What medications or supplements do you take regularly?

Your time with your doctor is limited. Preparing a list of questions to ask may help you make the most of your time together. For H. pylori infection, some basic questions to ask your doctor include:

  • How did H. pylori infection cause the complications I'm experiencing?
  • Can H. pylori cause other complications?
  • What kinds of tests do I need?
  • Do these tests require any special preparation?
  • What treatments are available?
  • How will I know if the treatment worked?

As you talk, ask additional questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Do you take any over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)?
May 18, 2021
  1. Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/all-content. Accessed Jan. 9, 2017.
  2. Papadakis MA, et al., eds. Gastrointestinal disorders. In: Current Medical Diagnosis & Treatment 2017. 56th ed. New York, N.Y.: The McGraw-Hill Companies; 2017. http://www.accessmedicine.com. Accessed Jan. 9, 2017.
  3. Helicobacter pylori infection. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-ulcer-disease/helicobacter-pylori-infection. Accessed May 6, 2021.
  4. Helicobacter pylori and cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/h-pylori-fact-sheet. Accessed Jan. 9, 2017.
  5. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. American College of Gastroenterology. http://gi.org/guideline/management-of-helicobacter-pylori-infection/. Accessed Jan. 9, 2017.
  6. Crowe SE. Bacteriology and epidemiology of Helicobacter pylori infection. http://www.uptodate.com/home. Accessed Jan. 9, 2017.
  7. Crowe SE. Indications and diagnostic tests for Helicobacter pylori infection. http://www.uptodate.com/home. Accessed May 6, 2021.
  8. AskMayoExpert. Helicobacter pylori (adult). Mayo Clinic; 2020.

Related

Associated Procedures

Helicobacter pylori (H. pylori) infection