Diagnostic and treatment guidelines for Helicobacter pylori

Helicobacter pylori (H. pylori) has been implicated as the causative agent for most gastric and duodenal ulcers. Many patients who present to their primary care provider with dyspeptic symptoms have heard of this "stomach bacteria" and ask if they should be tested and treated for the infection. Prior to diagnosing the presence of the organism, it is essential to determine whether it is likely to be responsible for patients' symptoms. Most patients with ulcer-like symptoms do not have peptic ulcer disease. Moreover, the background prevalence of H. pylori may be high, depending on the age, race, and socioeconomic status of the patient population. Thus, antibiotic treatment to eradicate H. pylori may not provide symptom relief. H. pylori can currently be diagnosed by serology or by a number of techniques involving endoscopic biopsy. In the near future, urea breath testing will likely become the noninvasive method of choice for diagnosing and monitoring the success of treatment for H. pylori in the primary care setting. This article discusses the current issues related to diagnosis and treatment of H. pylori as they relate to the primary care provider and offers insight as to when specialty referrals should be considered.