11/25/2025
I was wrong about H pylori testing 🙅
I don’t always have time to do a deep dive, but this morning I was inspired
I dug into sensitivity and specificity data on stool antigen and PCR testing for H pylori
🤓 Sensitivity is risk of false positive, higher the percentage more likely to be true positive
🤓 Specificity is risk of false negative, higher the percentage less likely to be false positive
These numbers varied depending on the research looking at symptomatic groups vs unsymptomatic groups
It’s estimated that more than half the world’s population are carriers for H pylori but only about 10% of those go on to have symptoms of ulcers, even reflux is now considered a reason to test
The best test hands down is biopsy 🥩 through EGD, or upper endoscopy
The breathe test is being used less but had the highest specificity and sensitivity after biopsy, it’s being used less now because we know there are other bugs that produce urea besides H pylori
Stool antigen test is most cost effective and carries a similar sensitivity and specificity to PCR 🧬 testing
BUT
The stool antigen test requires 🛑 PPIs, NSAIDs like ibuprofen and antibiotics 2 weeks before testing, which PCR does not need to 🛑 these medications
The aspect of PCR 🧬 I was correct was that it can detect DNA fragments from H pylori even after the infection is ‘gone’ so it’s not best for retesting
And whether I care about this or not, there are no PCR 🧬 tests for H pylori that have FDA clearance
H pylori, hiatal hernia, low stomach acid, overuse of ibuprofen and antibiotics all have a similar relationship
TL/DR
If already getting an upper endoscopy, have a biopsy 🥩 then retest with stool antigen test
If scope is not an option then PCR 🧬 may be a better test given that meds don’t need to be stopped but retest should be done with stool antigen test
If you are interested in mentoring with me to get your reflux under control and off your medications, drop a 🧬 and let’s chat
