H. Pylori Should Be Tested for Antibiotic Resistance Before Treatment, Says NEJM

The New England Journal of Medicine (NEJM) has posted guidance stating that Helicobacter pylori (H. Pylori) — a bacterial infection of the stomach lining that affects a large proportion of the global population — should be treated as an infectious disease, with antibiotic choices ideally shaped by testing that shows which drugs the bacteria will respond to.

The journal’s position is that antimicrobial-susceptibility testing (checking which antibiotics can actually kill the specific strain a patient carries) should guide prescribing whenever it is available. Both culture-based methods, which grow the bacteria in a lab to observe how it reacts to different drugs, and molecular methods, which analyse the bacteria’s genetic material for known resistance markers, are identified as valid approaches.

The call reflects wider concern in medicine about antimicrobial resistance — where bacteria evolve to survive drugs that once killed them. Prescribing the wrong antibiotic for H. Pylori not only fails the patient but can strengthen resistant strains.

H. Pylori is one of the most common bacterial infections worldwide. It can cause stomach ulcers and, in some cases, is linked to stomach cancer. Many people carry it without symptoms.

If you’re concerned about digestive symptoms, speak to your GP rather than self-treating. NHS 111 can also advise on next steps.

Key information

• H. Pylori symptoms can include persistent indigestion, bloating, stomach pain, or nausea — but many people have none at all
• Testing is available through your GP, usually via a breath test, stool test, or endoscopy
• Do not stop or change antibiotics without speaking to your GP first
• NHS 111 (call 111 or use the online service) can advise if you’re unsure whether to seek care