Which test for Helicobacter pylori in primary care?

Around 4% of primary care consultations are for dyspepsia, a term used for a specific group of upper gastrointestinal symptoms that includes abdominal discomfort, recurrent epigastric pain, bloating and heartburn. National guidelines recommend testing patients with uncomplicated dyspepsia for Helicobacter pylori infection, giving eradication therapy to those found to be infected and re-testing those who remain symptomatic after such treatment. Non-invasive tests for H. pylori avoid the need for endoscopy and biopsy to confirm infection, and several are now available for use in primary care. Here we review these tests and consider their role in the management of adults with dyspepsia.