Helicobacter pylori (H. pylori) Testing
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- Also Known As:
- H. pylori stool antigen
- H. pylori breath tests
- Urea breath test
- CLO test
- Rapid urease test (RUT) for H. pylori

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At a Glance
Why Get Tested?
To diagnose an infection with Helicobacter pylori (H. pylori), the bacteria that can cause a peptic ulcer, which is a sore on the lining of the stomach, small intestine or esophagus; to determine whether treatment has cured the infection
When To Get Tested?
When you have symptoms of an ulcer, such as ongoing indigestion, gastrointestinal pain that comes and goes, unexplained weight loss, nausea and/or vomiting; about 4-6 weeks after completing treatment for the infection
Sample Required?
A stool sample, a breath sample, or a tissue biopsy of the stomach lining
Test Preparation Needed?
You may need to avoid certain medications; follow any instructions you are given.
What is being tested?
Helicobacter pylori is a type of bacteria that is known to be a major cause of peptic ulcers, which are sores on the lining of the esophagus, stomach or small intestine. H. pylori testing detects an infection of the digestive tract caused by the bacteria to help diagnose the cause of symptoms and/or ulcers.
H. pylori infections of the digestive tract are very common, with as many as half of the world’s population infected. However, most people with H. pylori never have any symptoms. Still, H. pylori infection increases the risk of developing ulcers (peptic ulcer disease), persistent stomach inflammation (gastritis), and gastric (stomach) cancer. The bacteria decrease the stomach’s ability to produce mucus, making the stomach prone to damage from digestive acid and peptic ulcers.
A few different types of H. pylori testing are available, such as a stool antigen test and a breath test. Some are less invasive than others.
How is the sample collected for testing?
The sample collected depends on the test ordered:
- For the urea breath test, a health care professional collects an initial sample of your breath by having you breathe into a bag. You are given a liquid to drink containing a substance called urea. Another breath sample is collected after a specific amount of time has elapsed.
- For the stool antigen test, a stool sample is collected in a clean container.
A more invasive test will require a procedure called an endoscopy, which involves putting a thin tube with a tiny camera on the end down the throat into the stomach. This allows your health care practitioner to view the stomach lining and take a small piece of tissue (a biopsy) from the lining for examination.
Is any test preparation needed to ensure the quality of the sample?
For the breath test, you may be instructed to refrain from taking certain medications:
- Four weeks before the test, do not take any antibiotics or oral bismuth subsalicylate (Pepto Bismol®).
- Two weeks before the test, do not take any prescription or over-the-counter proton pump inhibitors, such as omeprazole, lansoprazole, or esomeprazole.
- One hour before the test, do not eat or drink anything (including water).
If submitting a stool sample or having a tissue biopsy collected, it may be necessary to refrain from taking any antibiotics, antacids, or bismuth treatments for 14 days prior to the test.
If undergoing endoscopy, fasting, usually overnight, may be required. Only water may be permitted.
Common Questions
View Sources
Sources Used in Current Review
Santacroce, L. and Bhutani, M. (2018 August 9, Updated). Helicobacter Pylori Infection. Medscape Gastroenterology. Available online at https://emedicine.medscape.com/article/176938-overview. Accessed on 9/08/18.
Lai, S. (2017 August 1, Updated). Tests for H. pylori. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/007501.htm. Accessed on 9/08/18.
Couturier, M. and Jarboe, E. (2018 August, Updated). Helicobacter pylori. ARUP Consult. Available online at https://arupconsult.com/content/helicobacter-pylori. Accessed on 9/08/18.
Zingman, B. et. al. (2017 October 12, Updated). Helicobacter pylori infection. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/007715.htm. Accessed on 9/08/18.
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(April 5, 2017) Armand W. H. pylori, a true stomach “bug”: Who should doctors test and treat? Harvard Health. Available online at https://www.health.harvard.edu/blog/h-pylori-a-true-stomach-bug-who-should-doctors-test-and-treat-2017040511328. Accessed Sep 2018.
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Sources Used in Previous Reviews
The Cleveland Clinic Health Information Center. Breath Test for H. pylori (Online information). Available online at http://www.clevelandclinic.org/health/. Accessed February 2008.
Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006.
Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott’s Diagnostic Microbiology 12th Edition: Mosby Elsevier, St. Louis, MO; 2007.
Chisholm SA, Owen RJ. Application of polymerase chain reaction-based assays for rapid identification and antibiotic resistance screening of Helicobacter pylori in gastric biopsies. Diagn Microbiol Infect Dis. 2008 Jan 11.
Siddique I, et. al Diagnosis of Helicobacter pylori: Improving the Sensitivity of CLOtest by Increasing the Number of Gastric Antral Biopsies. J Clin Gastroenterol. 2008 Apr;42(4):356-360.
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National Digestive Diseases Information Clearinghouse. H. pylori and Peptic Ulcer. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/. Accessed June 2011.
Michael Selgrad, Arne Kandulski and Peter Malfertheiner. Helicobacter pylori: Diagnosis and Treatment: Diagnosis of Helicobacter pylori. Curr Opin Gastroenterol. 2009;25(6):549-556. Available online at http://www.medscape.com/viewarticle/711405_2. Accessed June 2011.
Baumann, A. and Katz, P. (Updated 2014 January 27). Helicobacter Pylori Antigen Test. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2117821-overview. Accessed October 2014.
Santacroce, L. and Bhutani, M. (Updated 2014 September 11). Helicobacter Pylori Infection. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/176938-overview. Accessed October 2014.
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(2013 November). Helicobacter pylori Infection: Test Utilization Strategies for Diagnosis. Communique, Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/articles/communique/2013/11-hpylori-infection/. Accessed October 2014.
Kelly, J. (2014 September 30). WHO Urges H pylori Screening to Prevent Gastric Cancer. Medscape News [On-line information]. Available online at http://www.medscape.com/viewarticle/832581. Accessed October 2014.
Baron, E. et. al. (2013 July 10). A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). [On-line information]. Available online through http://www.idsociety.org. Accessed October 2014.
Pagana, K. D., Pagana, T. J., and Pagana, T. N. (© 2015). Mosby’s Diagnostic & Laboratory Test Reference 12th Edition: Mosby, Inc., Saint Louis, MO. Pp 494-496.
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