E. Request an endoscopy – Explanation

This patient is less than 55 years old and does not have any red flags. As his initial
antibodies for Helicobacter pylori are negative and his symptoms have not resolved, it
would be appropriate to refer this patient for an endoscopy. On the other hand, if his
serum antibodies for Helicobacter pylori were initially positive, then a urea breath test
would be appropriate.

GENERAL MANAGEMENT FOR DYSPEPSIA, HELICOBACTER PYLORI TESTING

Whilst we have put in this diagram to use H. pylori antibody testinhg if no response to
lifestyle modifications and antacids, NICE recommends any locally validated test for H.
pylori which include the carbon-13 urea breath test, stool antigen test, or serum
antibody testing.

In practice, if the patient is taking proton pump inhibitors, remember to stop it 2 weeks
prior to performing urea breath test or stool antigen test.

The only one test that you need to remember for re-testing for H. pylori is carbon-13
urea breath test as NICe recommends this as there is still insufficient evidence to
recommend stool antigen test as a test for eradication. Serological tests have no value
in confirming successful eradication because the antibodies persist after successful
eradication.