An Updated Approach to Evaluation and Treatment of Helicobacter Pylori Infection

Benjamin R. Lloyd, MD; David A. Leiman, MD, MSHP


South Med J. 2019;112(7):392-398. 

In This Article

Abstract and Introduction


Helicobacter pylori is a chronic bacterial infection that can lead to peptic ulcer disease, chronic gastritis, and gastric cancer. Its prevalence in the United States is lower than in most of the world, although specific populations are at particular risk for disease-related complications, including those with lower socioeconomic status and older adults. Since its discovery, there have been advances in H. pylori diagnosis and treatment, which are the focus of this review for general practice. Practice guidelines have expanded the role for treatment, despite traditional management algorithms resulting in diminished effectiveness as a result of increasing antibiotic resistance. In this context, new approaches warrant discussion. As such, this review aims to provide a clinical context and framework for the testing and rational treatment of H. pylori infection consistent with the available evidence.


Helicobacter pylori is an ancient bacterium and the most common pathogenic organism in humans, affecting approximately 50% of the world's population.[1] The prevalence of disease is not uniform, however. Its discovery by Marshall and Warren[2] revolutionized the understanding of peptic ulcer disease (PUD), and despite many advances, it remains an important cause of morbidity worldwide. In addition to PUD, it is a known risk factor for dyspepsia,[3] iron-deficiency anemia (IDA),[4] and gastric cancer.[5] The last decade has produced many advances in diagnostic testing, therapeutic approaches, and prevention of treatment failures. These advances have in turn led to updated testing and treatment paradigms published within the last year, which are particularly relevant for medical providers in North America.

This review summarizes the epidemiology of H. pylori infection within the United States. Indications for H. pylori testing, available diagnostic tests and their performance characteristics, and a treatment approach for the general practitioner also are discussed, with particular attention paid to the growing challenges of antibiotic resistance.