Explanation

Helicobacter pylori (stool): what is measured?

Helicobacter pylori is a bacterium that can live in the stomach lining, often from childhood. The bacterium can cause long-lasting inflammation of the stomach or of the first part of the small intestine. This test detects fragments of the bacterium (antigens) in a stool sample. A positive result means that the bacterium is present in the stomach at this moment.

What can it detect?

Infection with Helicobacter pylori, the stomach bacterium
One of the causes of a stomach ulcer or an ulcer in the first part of the small intestine
Checking whether the bacterium is gone after treatment

Result

What does the result mean?

Positive result

A positive result means that the stomach bacterium is present. Most people with this bacterium do not notice anything. In some, however, long-lasting inflammation of the stomach lining develops, with symptoms such as upper abdominal pain, nausea, a bloated feeling or quickly feeling full after eating. According to Thuisarts.nl, about 2 in 10 people with the bacterium develop a stomach ulcer at some point. For stomach complaints there is a treatment with antibiotics and an acid-reducing medicine.

Negative result

A negative result means that no signs of the stomach bacterium were found. Stomach complaints then have another cause, for example acid reflux or painkillers such as ibuprofen, naproxen or diclofenac. The result can be falsely negative if you used acid-reducing medicines or antibiotics shortly before the test.

After an abnormal result

With a positive result and stomach complaints, the GP usually prescribes a 10-day course of two antibiotics and an acid-reducing medicine, followed by a follow-up test to see whether the bacterium is gone. With a negative result, the GP looks at other causes of the complaints.

Reliability

How reliable is the test?

With persistent or recurrent stomach complaints, the Dutch GP guideline (NHG) on stomach complaints prefers an antigen test in the stool, because it shows an infection at this moment. The result is only reliable if you stop the requested medicines in time. A positive result does not tell whether the complaints are actually caused by the bacterium.

What can affect the result?

Acid-reducing medicines of the proton pump inhibitor type (for example omeprazole or pantoprazole) must be stopped 2 weeks before the test; other acid-reducing medicines such as famotidine 1 day beforehand.
No antibiotics may have been used in the 4 weeks before the test; otherwise the result may be falsely negative.
After treatment against the bacterium, it takes a few weeks before a follow-up test is reliable.
The quality of rapid stool tests varies; in children they have not proven reliable enough.

Preparation

Stop acid reducers such as omeprazole or pantoprazole 2 weeks beforehand. Check with your doctor if you cannot stop.
Do not use antibiotics in the 4 weeks before, otherwise the test can miss the bacterium.

Who it is for

Who is the test useful for?

Useful for

According to the Dutch GP guideline (NHG) on stomach complaints, useful with persistent or recurrent stomach complaints before you start an acid-reducing medicine, in people who lived as a child in an area where the bacterium is common, and as a check after treatment against the bacterium. In people without stomach complaints, a positive result says less: most people with the bacterium do not notice anything, and whether treatment is then worthwhile has not been established.

How common is it?

An estimated 20 in 100 people in the Netherlands have the stomach bacterium, and about 30 to 35 in 100 of people with stomach complaints; the number is falling. In people who grew up in countries around the Mediterranean, Eastern Europe, the Middle East, Asia, Africa, or Central and South America, this can rise to 75 in 100. Stomach and duodenal ulcers are largely caused by this bacterium.

Huisarts & Migrant (knowledge platform for GPs) and Thuisarts.nl

Drawbacks and risks

A positive result without symptoms can lead to a course of antibiotics whose benefit in that situation has not been established, with a chance of side effects.
A falsely negative result due to acid-reducing medicines or antibiotics can give false reassurance.

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