H. pylori test: which one to take and what your result means
Helicobacter pylori is a bacterium that lives in the acidic stomach and always inflames its lining, even when nothing hurts. To find it, use the urea breath test or the stool antigen test. A blood antibody test is almost useless for this: it can't tell a current infection from a past one.
Why it's worth getting rid of H. pylori
H. pylori is not a harmless neighbour. The Maastricht VI consensus treats H. pylori gastritis as an infectious disease, and the bacterium is the main risk factor for stomach cancer. The World Health Organization classifies it as a group 1 carcinogen, alongside smoking. It causes most stomach and duodenal ulcers, and the constant inflammation thins the stomach lining over time.
Sometimes treatment is not essential, for example when the bacterium was found by chance in someone with no symptoms and no risk factors. In real life, though, most people who test positive have either symptoms or a background that makes it worth removing.
Which H. pylori test to take
The urea breath test and the stool antigen test both show whether the bacterium is there right now. Both work for the first check and for confirming the result after treatment (Maastricht VI).
| Test | What it shows | When to use it | Preparation |
|---|---|---|---|
| Urea breath test | Whether the bacterium is there now | First check, and a check after treatment no earlier than 4 weeks later | Stop acid-reducing drugs (PPIs) 14 days before; wait 4–6 weeks after antibiotics or bismuth |
| Stool antigen test | Whether the bacterium is there now | Same; handy if there's nowhere to do a breath test | Same as for the breath test |
| Blood IgG antibodies | Can't tell a current infection from a past one | Not suitable for checking after treatment | — |
Urea breath test
You breathe into a bag before and after drinking a special solution. No tube to swallow, and it takes up to 30 minutes. The test shows whether the bacterium is present now, so it works both for the first check and after treatment.
Stool antigen test
The stool antigen test also detects a current infection and works for the same purposes. It's a good option if no lab nearby does the breath test.
Positive H. pylori blood test: do you still have it?
Not necessarily. A blood IgG antibody test can't tell a current infection from a past one: antibodies fall slowly and can stay positive for months after the bacterium is gone.
If you already have a positive blood result and don't know what to do with it, you're not alone — this is very common. Positive antibodies on their own don't mean the bacterium is in your stomach right now. Confirm it with a breath or stool antigen test.
How to prepare for the test
Medicines you took beforehand affect the result. Under Maastricht VI, proton pump inhibitors (omeprazole, pantoprazole and similar) are stopped 14 days before the test, and after antibiotics or bismuth you wait 4–6 weeks. Otherwise the test can come back falsely negative. Stop medicines only together with the doctor who prescribed them.
How to confirm H. pylori is gone after treatment
After eradication therapy — the course of drugs that kills the bacterium — a control test is a must, no earlier than 4 weeks after the course. The same two tests work: the urea breath test or the stool antigen test. Your doctor chooses the regimen and timing in person.
Don't take random antibiotics or herbal remedies on your own. They don't clear H. pylori; they make it resistant and make the next regimen harder to choose.
H. pylori myths that even doctors believe
"H. pylori can't be cured"
Not true. There are more than twenty approved eradication regimens. When the bacterium "stays" after a course, the reason is usually something else: the wrong regimen, antibiotic resistance, or a control test done with the wrong method.
"The rapid test during endoscopy was positive, so treatment failed"
The rapid urease test during endoscopy and blood antibodies are not suitable for checking after treatment. Under the Maastricht VI/Florence consensus, control is done only with the C13 breath test or the stool antigen test. Wrong control testing is exactly where the myth of "incurable" H. pylori comes from.
"You must take probiotics during the course"
No, they are not part of the standard regimens. Some strains — Lactobacillus rhamnosus GG and Saccharomyces boulardii — showed some effect in reducing side effects, mainly diarrhoea. They are an option, not a required part of treatment.
"After treatment you need to restore the stomach lining"
There's no reliable evidence for this. Clinics in post-Soviet countries often prescribe rebamipide for it, but the Japanese studies usually cited did not show a meaningful reduction in atrophy.
"Atrophy after H. pylori means cancer"
It's not that simple. Atrophy of the lower stomach (antrum), even with patches of intestinal metaplasia, is not a significant risk factor by itself. An active infection, especially together with autoimmune gastritis, does raise the risk of stomach cancer. That's why clearing the bacterium in time matters.
What else affects H. pylori
Salt. Too much salt makes the bacterium produce more CagA, a protein that makes it more aggressive and raises the risk of atrophy and cancer (Gut Microbes, 2020). A high-salt diet is a real additional risk factor.
Vitamin D. Deficiency raises the risk of infection and lowers the chance of clearing it: vitamin D helps the stomach lining make its own antimicrobial proteins (Nature Communications, 2022). With chronic gastritis or repeated positive tests, it's worth checking your vitamin D.
When to see a doctor in person
Don't delay if you have black stools or vomit blood, trouble swallowing, unexplained weight loss, anaemia, new stomach symptoms after 50, or stomach cancer in close relatives. Under Maastricht VI these cases need an upper endoscopy (gastroscopy), not just an H. pylori test.
Sources
Tested positive, finished a course and not sure it worked, or had your control done with a rapid test? Let's go through your results together.