Choosing Wisely:

Don’t request serology for Helicobacter pylori. Use the stool antigen or breath tests instead.

Rationale and Comments: Serologic evaluation of patients to determine the presence/absence of H. pylori infection is no longer considered clinically useful. Alternative noninvasive testing methods (e.g., the urea breath test and stool antigen test) exist for detecting the presence of the bacteria and have demonstrated higher clinical utility, sensitivity, and specificity. Additionally, both the American College of Gastroenterology and the American Gastroenterology Association recommend either the breath or stool antigen tests as the preferred testing modalities for active H. pylori infection. Finally, several laboratories have dropped the serological test from their menus, and many insurance providers are no longer reimbursing patients for serologic testing.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gastroenterologic
  • References: • Babak Pourakbari, Mona Ghazi, Shima Mahmoudi, Setareh Mamishi, Hossein Azhdarkosh, Mehri Najafi, Bahram Kazemi, Ali Salavati, and Akbar Mirsalehian. Diagnosis of Helicobacter pylori infection by invasive and noninvasive tests. Braz J Microbiol. 2013; 44(3): 795–798. Published online 2013 Nov 15.
    • Elvira Garza-González, Guillermo Ignacio Perez-Perez, Héctor Jesús Maldonado-Garza, and Francisco Javier Bosques-Padilla. A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication. World J Gastroenterol. 2014 Feb 14; 20(6): 1438–1449. Published online 2014 Feb 14. doi: 10.3748/wjg.v20.i6.1438
    • Theel ES, Johnson RD, Plumhoff E, Hanson CA. Use of the Optum Labs Data Warehouse to assess test ordering patterns for diagnosis of Helicobacter pylori infection in the United States. J Clin Microbiol 2015 Apr;53(4):1358-1360
    • Wang YK, Kuo FC, Liu CJ, Wu MC, Shih HY, Wang SS, Wu JY, Kuo CH, Huang YK, Wu DC. Diagnosis of Helicobacter pylori infection: Current options and developments. World J Gastroenterol. 2015 Oct 28;21(40):11221-35. doi: 10.3748/wjg.v21.i40.11221.
    • Tamadon MR, Saberi Far M, Soleimani A, Ghorbani R, Semnani V, Malek F, Malek M. Evaluation of noninvasive tests for diagnosis of Helicobacter pylori infection in hemodialysis patients. J Nephropathol. 2013 Oct;2(4):249-53. Epub 2013 Sep 1.
    • Talley NJ, Ford AC. Functional Dyspepsia. The New England Journal of Medicine. 2015;373:1853-63. Published online 2015 November 5.

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