Suggested initial diagnostic evaluation in patients with suspected Helicobacter pylori infection

* Endoscopy is not indicated solely for the purpose of establishing H. pylori status.
¶ PPI use within one to two weeks and bismuth/antibiotic use within four weeks of testing can decrease sensitivity for H. pylori. When feasible, PPIs should be discontinued one to two weeks prior to testing and testing should be performed at least four weeks after last bismuth/antibiotic use.
Δ The choice of test depends on local availability. Serologic testing for H. pylori should not be performed.
◊ If biopsy urease test is not available, gastric biopsies should be performed for histology.
§ In patients with actively bleeding peptic ulcer on upper endoscopy, testing for H. pylori with a urea breath test or stool antigen can be performed when there is no evidence of ongoing bleeding and PPIs can safely be discontinued for one to two weeks prior to testing.