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Helicobacter Pylori Infection

NICE Clinical guideline [CG184] Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Last updated: Oct 2019.

BNF Treatment summaries. Helicobacter pylori infection.

UK Health Security Agency Guidance Helicobacter pylori in dyspepsia: test and treat. Last updated: May 2025.

Article Last Updated: 23 November 2025

Background information added accordingly. Minor changes and restructuring to the diagnosis and management sections, based on UK Health Security Agency Guidance.

Date: 23 November 2025

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Background Information

Causative Agent

Pathophysiology

Clinical Features

Diagnosis

Investigation and Diagnosis

Test	Description	Interpretation
Urea 13C breath test	Preferred test (most accurate test)	↑ ¹³C in exhaled breath = *active H. pylori* infection**
Stool antigen test	Preferred test	Positive = current active infection
Serology (IgG)	Low accuracy (not recommended for most patients) (+ve tests should be confirmed by a second test	Positive = past or current exposure (not reliable for active infection)

Management

Offer H. pylori eradication to those with +ve H. pylori testing (urea breath test or stool antigen test)

Standard regimen: triple-therapy regimen (1 PPIProton pump inhibitor and 2 antibiotics)

Early-stage of gastric MALT lymphoma can be effectively treated with H. pylori eradication

Choice of H. Pylori Eradication Therapy

	Patients with NO penicillin allergy	Patients WITH penicillin allergy
1st line	7 days triple therapy of: PPI twice daily, and Amoxicillin, and Clarithromycin or metronidazole	7 days triple therapy of: PPI twice daily, and Clarithromycin, and Metronidazole
2nd line (ongoing symptoms after 1st line)	7 days triple therapy of: PPI twice daily, and Amoxicillin, and Whichever antibiotic that is NOT used as 1st line (clarithromycin or metronidazole)	7-days quadruple therapy of: PPI twice daily, and Bismuth, and Tetracycline, and Metronidazole

Re-Testing

References

NICE guideline Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
BNF Treatment summaries Helicobacter pylori infection

UK Health Security Agency Guidance Helicobacter pylori in dyspepsia: test and treat

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