Indications for Helicobacter pylori Testing During Esophagogastroduodenoscopy

Helicobacter pylori (H. pylori) infection is the most prevalent chronic bacterial infection in the world and is associated with chronic gastritis such as atrophic gastritis and intestinal metaplasia, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. When to diagnose and treat H. pylori infection were already described in the previous chapter, and endoscopic diagnosis of H. pylori infection will be dealt in the next chapter. Prior to performing esophagogastroduodenoscopy (EGD), endoscopists are aware of patient information such as symptoms, medical history, laboratory data (e.g., dyspepsia, heartburn, use of nonsteroidal anti-inflammatory drugs [NSAIDs], or thrombocytopenia), and previous history of gastric lesions, such as peptic ulcer or gastric epithelial neoplasia, and, as such, perform invasive H. pylori tests (rapid urease test, histopathological examination, or culture) during endoscopy. However, in cases of health check-up endoscopy, endoscopists often perform EGD without any clinical information. Accordingly, this chapter discusses when to perform H. pylori tests during EGD based on endoscopic findings alone.