How to test?
Urea Breath Test (UBT), validated stool antigen test and as a close second validated IgG serology (not useful for follow-up, best test if you use acid-suppressing drugs).
„Several non-invasive H pylori tests are established in clinical routine. The UBT [Urea Breath Test (UBT)] using essentially [13C]urea remains the best test to diagnose H pylori infection, has a high accuracy and is easy to perform.76 During recent years new formats of the SAT [stool antigen test] (using monoclonal antibodies instead of polyclonal antibodies, which lead to a constant quality of the reagents have been developed. The two formats available are: (1) laboratory tests (ELISAs) and (2) rapid in-office tests using an immunochromatographic technique. A meta-analysis of 22 studies including 2499 patients showed that laboratory SATs using monoclonal antibodies have a high accuracy both for initial and post-treatment diagnosis of H pylori.77 These data have been confirmed by more recent studies.78 79 In contrast, the rapid in-office tests have a limited accuracy.80 81 Therefore, when a SAT has to be used the recommendation is to use an ELISA format with a monoclonal antibody as reagent.“And:
The Urea Breath Test (UBT) and stool antigen testing are acceptable non-invasive tests for H pylori infection in this setting. For UBT, sensitivity is 88-95% and specificity 95%-100%.4 Stool antigen testing may be somewhat less acceptable to patients in some cultures but is equally valid, with a sensitivity of 94% and a specificity of 92%.5
How to treat?
The standard is triple treatment including PPI(acid inhibition) clarithromycin, and amoxicillin (or metronidazole), but can be further improved. Talk to your gastroenterologist.
Proton pump inhibitor (PPI)-clarithromycin containing triple therapy without prior susceptibility testing should be abandoned when the clarithromycin resistance rate in the region is over 15-20%
The use of high-dose (twice a day) PPI increases the efficacy of triple therapy [esomeprazole preferred; perhaps slow phase-out vs rebound-reflux disease?]
Extending the duration of PPI-clarithromycin-containing triple treatment from 7 to 10-14 days improves the eradication success by approximately 5% and may be considered
Certain probiotics and prebiotics show promising results as an adjuvant treatment in reducing side effects [I'd recommend lactoferrin because of its safety]
Against inducing antibiotic resistance: hygiene and sanitation (don’t transfer the resistant germs), 100% compliance if possible, state of the art therapy with high acid suppression (increases specificity for the stomach), watch out for local patterns of resistance.
[1a] Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Malfertheiner et al.