Helicobacter Pylori Screening Guidelines

Indications for Screening

The European Society recommends screening for Helicobacter pylori in patients with a history of gastric surgery, previous gastric neoplasia, pangastritis, or atrophic gastritis with a high risk of gastric cancer 1
Patients with gastric ulcers or duodenal ulcers, active or with documented history, should be screened for Helicobacter pylori 2, 3
The European Society suggests screening for Helicobacter pylori in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma 1
Patients who have undergone endoscopic or surgical resection of early gastric cancer should be screened for Helicobacter pylori 3
The European Society recommends screening for Helicobacter pylori in patients with atrophic gastritis or intestinal metaplasia 1

Patients with a family history of gastric cancer, particularly first-degree relatives, should be screened for Helicobacter pylori 1
Patients with CDH-1 mutation should be screened for Helicobacter pylori and considered for genetic consultation and prophylactic gastrectomy 1
Patients with severe pangastritis or atrophic gastritis with a high risk of gastric cancer should be screened for Helicobacter pylori 1

Patients requiring long-term acid suppressive therapy (>1 year) should be screened for Helicobacter pylori 1, 2
Patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin, particularly those at high risk of gastrointestinal complications, should be screened for Helicobacter pylori 3

A "test and treat" strategy is recommended for patients with dyspepsia in populations with high Helicobacter pylori prevalence (≥20%) 4, 5
This approach is not applicable to patients with alarm symptoms or older patients, with the age limit determined locally based on gastric cancer risk 4

Patients with confirmed pernicious anemia and histological confirmation of autoimmune atrophic gastritis type A should undergo endoscopic surveillance 6
Patients with histological and/or serological signs of subtotal or total atrophic gastritis with hypo- or achlorhydria should undergo endoscopic surveillance 6
Patients with a diagnosis or removal of gastric adenoma(s) should undergo endoscopic surveillance 6

Patients with significant environmental risk factors for gastric cancer (heavy smoking, high exposure to dust, coal, quartz, cement, and/or working in quarries) should be tested for Helicobacter pylori 1
Helicobacter pylori-positive patients expressing fear of gastric cancer may also benefit from testing and treatment 1

Regular follow-up is recommended every 2-3 years in cases of moderate to severe atrophy and every 3-6 months in cases of dysplasia 6
Confirmation of eradication is recommended, ideally by urea breath test (13C-UBT) or monoclonal fecal antigen test 4

Antibiotic resistance is the most important factor responsible for the decline in Helicobacter pylori eradication treatment success rates 1
Local surveillance of antibiotic resistance is mandatory, and the combination of antibiotics for eradication treatment should be chosen based on local resistance profiles 1
Serological tests should not be used to evaluate the success or failure of treatment, as the decrease in antibody titers may take up to six months 2, 7