Management in patients with discordant H pylori test results

Paul Moayyedi, MB, is a professor of medicine and assistant dean of research in the Faculty of Health Sciences at McMaster University.

What should be the management in a patient with 2 discordant Helicobacter pylori test results (a negative stool antigen test and positive Campylobacter-like organism [CLO] test, or the other way round)? Should one of these results be considered more reliable and determine further management? Or should a third test be performed? If yes, which one? Should eradication be recommended whenever at least one test suggests the presence of H pylori?

I believe if at least 1 test is positive, then you should treat.

The exception would be serology. Serology is your immune response to the organism—which of course may have spontaneously cleared or may have been treated before, but you still may be serologically positive. So you don’t just rely on serology. If the other tests are negative, in fact you’d go with the other tests.

In the case of the example you gave, of the fecal antigen test or the CLO test, whichever is positive, you would treat as positive.