Should You Test for H. Pylori After Endoscopy for GERD Symptoms?

After undergoing an upper gastrointestinal endoscopy and taking the medication, the symptoms still persist..?

About a year ago, I had an upper gastrointestinal endoscopy, and the doctor diagnosed me with gastroesophageal reflux disease (GERD) and gastritis.
At that time, the doctor only advised me to take medication, and since there were no ulcers, they did not test for Helicobacter pylori.
I completed a three-month course of proton pump inhibitors but did not continue afterward.
Since finishing the medication, my stomach condition has been variable.
When I feel fine, I experience a sensation of tightness and discomfort, but no pain.
When I have symptoms, I feel overall discomfort, GERD symptoms, nausea, and loss of appetite, and sometimes I do experience pain.
I also feel uncomfortable when I am too hungry or too full.
Doctor, do you think I should get tested for Helicobacter pylori? Besides endoscopy, what other testing methods do you recommend? How much does it typically cost, and how long will it take to get results? If the test is positive, will the doctor prescribe medication? P.S.
I had a physical examination during my military service, but I was not informed whether I had Helicobacter pylori.
Thank you, doctor!

IOU, 20~29 year old female. Ask Date: 2012/08/11

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, (1) To clarify, Helicobacter pylori is not directly related to gastroesophageal reflux disease (GERD).
(2) If you have been diagnosed with a Helicobacter pylori infection but do not have a history of gastric ulcers, duodenal ulcers, gastric lymphoma, a history of gastric cancer surgery, a family history of gastric cancer, non-ulcer dyspepsia, or long-term use of painkillers, there is no need for antibiotic treatment to eradicate the bacteria.
(3) There are various methods to test for Helicobacter pylori: the carbon-13 urea breath test, stool antigen test for Helicobacter pylori, endoscopic biopsy with pathological examination, and endoscopic urease test, all of which can detect the presence of the bacteria.
Blood tests for Helicobacter pylori antibodies cannot determine if there is an active infection.
(4) If a physician diagnoses you with indications for testing for Helicobacter pylori, then health insurance will cover the costs; however, if it is purely for a health check-up, it will be out-of-pocket, and you should consult the health check-up department of the hospital for pricing.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2012/08/11

More Info

When considering whether to test for Helicobacter pylori (H. pylori) after experiencing symptoms related to gastroesophageal reflux disease (GERD) and gastritis, it is essential to understand the relationship between these conditions and the potential role of H. pylori in your gastrointestinal health.

H. pylori is a type of bacteria that can infect the stomach lining and is known to cause chronic gastritis, peptic ulcers, and is associated with an increased risk of gastric cancer. However, not everyone infected with H. pylori will develop these conditions. Symptoms such as bloating, discomfort, and nausea can arise from various causes, including stress, dietary habits, and other gastrointestinal disorders.

Given your history of GERD and gastritis, along with the ongoing symptoms you describe—such as a feeling of tightness in the stomach, discomfort after eating, and occasional pain—it may be prudent to test for H. pylori. While your previous endoscopy did not indicate ulcers or severe inflammation that would necessitate immediate testing for H. pylori, the persistence of your symptoms suggests that further investigation could be beneficial.

There are several methods to test for H. pylori:
1. Endoscopy with Biopsy: This is the most definitive method. During an endoscopy, a doctor can take a biopsy of the stomach lining to check for the presence of H. pylori. However, this method is invasive and typically reserved for cases where other serious conditions are suspected.

2. Urea Breath Test (UBT): This non-invasive test is highly accurate and involves drinking a solution containing a special type of urea. If H. pylori is present, it will break down the urea, and the resulting carbon dioxide can be detected in your breath. This test is generally preferred for its accuracy and ease of use.

3. Blood Test: A blood test can detect antibodies to H. pylori. However, this method is less reliable for determining current infection because antibodies can remain in the bloodstream long after the infection has cleared.

4. Stool Antigen Test: This test checks for H. pylori antigens in a stool sample. It is also a non-invasive and reliable method for diagnosing an active infection.

Regarding costs, the price of these tests can vary significantly based on your location and whether you have insurance coverage. Typically, a urea breath test or stool antigen test may range from $100 to $300, while an endoscopy can be much more expensive, often exceeding $1,000, depending on the facility and any additional procedures performed.

Results from the urea breath test or stool antigen test are usually available within a few days, while biopsy results from an endoscopy may take longer, typically about a week.

If H. pylori is detected, your doctor will likely prescribe a combination of antibiotics and proton pump inhibitors (PPIs) to eradicate the infection. This treatment is usually effective, but it's essential to complete the entire course of antibiotics to prevent resistance.

In summary, given your ongoing symptoms and history, testing for H. pylori could provide valuable information and potentially lead to a more effective treatment plan. Discussing your concerns with your healthcare provider will help determine the most appropriate testing method for your situation.

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