Helicobacter pylori: to treat or not to treat

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.