Whether to treat Helicobacter pylori infection is a common problem for GPs. Benefits from successful treatment are yet to be unequivocally determined in patients other than those with a current or past history of peptic ulceration or those in whom the rare gastric MALT lymphoma has been diagnosed.
The prevalence of infection with Helicobacter pylori varies widely. In Australia, up to 40% of the population is infected, while in some developing countries this figure is greater than 90%. In most cases, infection is acquired in childhood, probably through faecal–oral spread. The success of a course of eradication therapy (typically triple therapy) can be established by a urea breath test or, in the case of a gastric ulcer or a complicated (e.g. bleeding) duodenal ulcer, by histology or a rapid urease test performed on gastric biopsies taken at follow up gastroscopy to assess healing. Once successfully treated, re-infection is rare.