Recently, pts. have become aware of the prevalance of H. pylori as a cause of ulcers and questioning why I don’t emperically tx. for it, rather than an initial trial of PPI’s. My response is that although H. pylori is present in >80% of ulcers, is has only been implicated as causative in ~20%. Plus, the potential risk of SE’s from triple therapy.

Blood test is easy. Unfortunately it detects antibodies, not infection. May remain positive for years even after eradication of infection. Detecting IgM vs. IgG is not always reliable.

Urea breath test and stool antigen test detect infection. As does biopsy for either rapid urease test or histology with special stains. Biopsy is most invasive, most expensive, and most accurate.