H.pylori

Helicobacter pylori (formerly named Campylobacter pylori) is a gram negative S shaped or spiral bacillus, described as a Unipolar flagellate, 1 by 3 micrometres in size. It is a microaerophilic, and produces urease and other toxins.

Infection with Helicobacter pylori is common in patients with peptic ulceration. A short course of standard ulcer treatment usually heals ulceration but about 85% of patients relapse within a year. In patients with duodenal ulcer, eradication of H. pylori causes the relapse rate to fall to 0 - 20%.

The best test for identification of H Pylori and for confirmation of eradication is the 13C urea breath test (1,2).

A review assessing the efficacy and cost-effectiveness of the 13C-urea breath test as the primary diagnostic investigation for the detection of Helicobacter pylori infection compared to invasive and non-invasive diagnostic tests notes (3):

• sensitivity and specificity higher than 90% was found in 84% of the studies for the 13C-urea breath test
• sensitivity and specificity higher than 90% was found in 62% of the studies for the stool antigen test, and 56% sensitivity and 44% specificity for the IgG test

Reference:

1. BSG (2002) Dyspepsia management guidelines.
2. PHE (2019). Test and treat for Helicobacter pylori (HP) in dyspepsia - Quick reference guide for primary care:For consultation and local adaptation.
3. Nocon M et al. Efficacy and cost-effectiveness of the 13C-urea breath test as the primary diagnostic investigation for the detection of Helicobacter pylori infection compared to invasive and non-invasive diagnostic tests. GMS Health Technol Assess. 2009 Oct 21;5:Doc14.