Lab result explainedInflammationLast updated November 10, 2026

H. pylori test: breath, stool and blood tests, how to prepare and what a positive result means

H. pylori test (H. pylori) · Helicobacter pylori testing (urea breath test, stool antigen, serology, biopsy) · reported in Reported as positive or negative (breath test: delta over baseline in per mil; stool antigen: positive/negative; blood IgG: index value or U/mL against the lab cutoff)

Helicobacter pylori is a spiral bacterium that lives in the stomach lining of roughly a third of US adults and about half the world's population, usually picked up in childhood and usually silent. In a minority it causes gastritis, stomach and duodenal ulcers and, over decades, stomach cancer; it is also linked to unexplained iron deficiency, low vitamin B12 and immune thrombocytopenia. An H. pylori test finds out whether the bacterium is present, and there are three common ways to do it without an endoscopy: a urea breath test, a stool antigen test and a blood antibody test.

The breath and stool tests detect active infection and are the ones guidelines recommend, with accuracy around 95 percent when done properly. The blood test detects antibodies, which can persist for years after the infection has gone, so a positive blood test cannot distinguish a current infection from one you cleared or were treated for a decade ago. Preparation matters more for H. pylori than for most tests: proton-pump inhibitors must be stopped for two weeks and antibiotics and bismuth for four weeks before a breath or stool test, or the result can be falsely negative.

A positive result is treated, because eradicating the bacterium heals ulcers, prevents them returning and lowers the lifetime risk of stomach cancer by roughly a third to a half. Treatment is a 10- to 14-day course of two or three antibiotics with an acid suppressant, after which everyone should be retested, at least four weeks after the last antibiotic, to confirm the bacterium is gone. Around 10 to 20 percent of first courses fail because of antibiotic resistance, which is why the eradication test is not optional.

H. pylori at a glance

  • What it is: testing for Helicobacter pylori, a stomach bacterium that causes gastritis, ulcers and raises stomach cancer risk.
  • Best tests: urea breath test (about 95 percent sensitive and specific) and stool antigen test (about 94 and 97 percent). Both detect active infection and are used after treatment to confirm it has cleared.
  • Blood (antibody) test: about 85 percent sensitive, 79 percent specific; stays positive for years after the infection is gone, so it cannot confirm active infection or eradication.
  • Preparation: no proton-pump inhibitors (omeprazole, pantoprazole and similar) for 2 weeks and no antibiotics or bismuth for 4 weeks before a breath or stool test; fast for at least 1 hour (many centers ask 4 to 6) before a breath test.
  • Positive = treat (two or three antibiotics plus an acid suppressant for 10 to 14 days), then retest at least 4 weeks after finishing to confirm eradication.
  • No diet, herb or supplement reliably clears H. pylori; some probiotics modestly improve the success and tolerability of antibiotic treatment.

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What H. pylori measures

H. pylori survives stomach acid by making large amounts of the enzyme urease, which splits urea into ammonia and carbon dioxide. The urea breath test exploits that: you swallow a small drink or capsule of urea labelled with a harmless carbon isotope (carbon-13, or a minute dose of carbon-14), wait 10 to 30 minutes, and breathe into a bag. If H. pylori is present, the labelled carbon dioxide appears in your breath, and the lab reports the rise over your baseline sample, usually as a 'delta over baseline' with a positive cutoff around 2.4 to 4 per mil depending on the system. The test takes about half an hour and detects current infection anywhere in the stomach.

The stool antigen test uses monoclonal antibodies to detect pieces of the bacterium shed in a small stool sample. It is as reliable as the breath test for diagnosis and for confirming eradication, is cheaper, and suits children and people who cannot do a breath test, with the same medication rules. Newer stool PCR tests can also identify clarithromycin-resistance genes, which helps choose antibiotics. The blood test measures IgG antibodies against the bacterium; it is unaffected by acid suppressants and antibiotics, which is sometimes useful, but because antibodies linger for one to three years or more after the bacterium is gone, a positive result means 'exposed at some point' rather than 'infected now'.

If you are having an endoscopy anyway (for example, because of bleeding, weight loss, difficulty swallowing, anemia or new symptoms over age 60), the bacterium can be tested on biopsies by a rapid urease test, by looking at the tissue under the microscope, or by culture or PCR, which also reveal antibiotic resistance. Whichever method is used, recent proton-pump inhibitors, antibiotics or bismuth suppress the bacterium enough to cause false negatives on every test except the blood test, and active bleeding in the stomach can do the same.

Normal range for H. pylori

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

GroupTypical range (Reported as positive or negative (breath test: delta over baseline in per mil; stool antigen: positive/negative; blood IgG: index value or U/mL against the lab cutoff))Notes
Urea breath test, negativeBelow the lab's cutoff (commonly 2.4 to 4.0 per mil delta over baseline)No active infection, provided proton-pump inhibitors were stopped for 2 weeks and antibiotics and bismuth for 4 weeks. Some labs report a narrow 'borderline' band just below the cutoff that is repeated in 2 to 4 weeks.
Urea breath test, positiveAt or above the cutoffActive infection. The size of the number does not indicate how severe the infection is or whether an ulcer is present.
Stool antigen, negativeNegativeNo active infection, with the same medication rules as the breath test. Watery diarrhea can dilute the sample and cause a false negative.
Stool antigen, positivePositiveActive infection. A positive result after treatment that was taken less than 4 weeks earlier is repeated rather than acted on.
Blood IgG antibody, negativeBelow the lab cutoffProbably never infected, though about 15 percent of infected people test negative. Antibody takes several weeks to appear after new infection.
Blood IgG antibody, positiveAbove the lab cutoffInfected now or at some time in the past. Needs a breath or stool test to confirm active infection before treatment, since 20 percent or more of positives in low-prevalence US populations are not current infections.
Biopsy rapid urease test, histology, culturePositive or negativeDone during endoscopy. Histology also grades gastritis and checks for precancerous change; culture or PCR reports antibiotic resistance.
Eradication test (breath or stool), 4 or more weeks after treatmentNegative = eradicated; positive = treatment failedRequired for everyone after treatment. About 10 to 20 percent of first-line courses fail; a second course uses different antibiotics.

Positive H. pylori test

A positive breath or stool test means H. pylori is living in your stomach now. Most people with the bacterium have no symptoms and never develop a problem, but over a lifetime about 10 to 20 percent develop a stomach or duodenal ulcer and 1 to 2 percent develop stomach cancer, and the bacterium is now considered the cause of the great majority of both. Because treatment removes that risk, current US and European guidelines recommend treating everyone who tests positive, whether or not they have symptoms. In people with indigestion-type symptoms (upper abdominal pain or discomfort, bloating, early fullness), eradication improves symptoms in roughly one in ten more people than placebo; in people with a proven ulcer it heals the ulcer and prevents recurrence in the large majority.

A positive blood antibody test means something different: you have been infected at some point. In parts of the US where the bacterium is uncommon, a sizeable share of positive blood tests are in people who have already cleared it, naturally or with previous antibiotics, so guidelines advise confirming with a breath or stool test before treating unless there is a strong reason, such as a known ulcer, to treat straight away. A positive blood test after treatment is expected and does not mean the treatment failed.

Treatment is a combination of two or three antibiotics (commonly bismuth with tetracycline and metronidazole, or amoxicillin with clarithromycin or a newer regimen) plus a strong acid suppressant for 10 to 14 days. Success rates with the recommended bismuth-based four-drug regimen are about 85 to 90 percent; older clarithromycin-based triple therapy now fails in 20 to 30 percent of people where clarithromycin resistance is common. Finishing every dose matters: missing doses is the leading avoidable cause of failure and of resistance. The 2024 American College of Gastroenterology guideline also recommends offering a breath or stool test (not a blood test) to adult household members of someone with a confirmed infection, because sharing a home is the main way the bacterium spreads; reinfection after successful treatment is uncommon in high-income countries, at about 1 to 2 percent a year.

Common causes

  1. Active Helicobacter pylori infection

    Acquired usually in childhood by close contact, shared utensils or contaminated water and food; the bacterium persists for life unless treated. Prevalence in the US is around 30 to 40 percent overall and higher in people born outside the US, in Hispanic, Black and Asian American communities, and in older adults.

  2. Past infection (blood antibody test only)

    IgG antibodies remain detectable for one to three years or more after the bacterium is cleared, so the blood test cannot tell current from past infection or confirm that treatment worked.

  3. Treatment failure

    A positive breath or stool test 4 or more weeks after a full course means the bacterium survived, usually because of clarithromycin, metronidazole or levofloxacin resistance (clarithromycin resistance now exceeds 15 to 20 percent in much of the US) or missed doses. A second-line regimen with different antibiotics is used.

  4. Retesting too soon after treatment

    Within 4 weeks of antibiotics, or within 2 weeks of a proton-pump inhibitor, a positive result is unreliable in both directions; the test is repeated once the washout is complete.

  5. Other urease-producing organisms (breath test)

    Rarely, other bacteria in the mouth or stomach produce urease and cause a weak false positive; most breath-test kits include a mouthwash step or citric acid drink to reduce this. Low stomach acid (atrophic gastritis, long-term acid suppression) allows other bacteria to grow and is the usual setting.

  6. Reinfection

    Uncommon in high-income countries (about 1 to 2 percent a year) but more frequent where the bacterium is widespread; a positive test years after successful eradication is more often reinfection than late relapse.

  7. Cross-reacting antibodies (blood test)

    Other Helicobacter species and some autoimmune conditions can produce a false-positive IgG, which is one reason the blood test's specificity is only about 79 percent.

Symptoms that can go with it

  • Often none at all; most infected people never have symptoms
  • Gnawing or burning pain in the upper abdomen, often between meals or at night and eased briefly by food or antacids
  • Bloating, early fullness, burping, nausea or loss of appetite
  • Black, tarry stools or vomiting blood, which signal a bleeding ulcer and need emergency care
  • Unexplained iron deficiency anemia that does not respond to iron tablets
  • Low vitamin B12 from reduced acid and intrinsic factor in long-standing gastritis
  • Unexplained low platelets (immune thrombocytopenia), which can improve after eradication
  • Unintended weight loss, difficulty swallowing or persistent vomiting, which are alarm features needing endoscopy

Negative H. pylori test

A negative breath or stool test done after the proper washout means it is very unlikely that H. pylori is in your stomach now: both tests miss only about 5 percent of infections. If your symptoms persist, the cause is probably something else, most often functional dyspepsia (a sensitive stomach with no visible damage), acid reflux, gallstones, medication irritation from NSAIDs or aspirin, or, less commonly, celiac disease, pancreatic disease or, in older people, a tumor. A negative blood test is a little less reassuring, since it misses roughly 15 percent of infections and may be negative in the first few weeks of a new one.

The commonest reason for a falsely negative breath or stool test is medication. Proton-pump inhibitors taken within the previous two weeks suppress the bacterium enough to produce a false negative in up to a third of infected people; antibiotics or bismuth within the previous four weeks do the same, and so can a recent bleeding ulcer, since blood in the stomach inhibits the bacterium. H2-blockers such as famotidine have little effect and are usually stopped only a day or two before. If you could not stop your acid suppressant, tell the clinic: a blood test, or a biopsy at endoscopy, may be the better option, or the test can be scheduled after a planned pause.

After treatment, a negative breath or stool test taken at least four weeks after the last antibiotic dose and two weeks off proton-pump inhibitors confirms eradication. Antibodies in the blood fall slowly, so a blood test is not used for this purpose; a positive blood test a year after successful treatment is expected and should not prompt further antibiotics. Successful eradication does not reverse all risk if the stomach lining is already scarred or precancerous, so people found at endoscopy to have atrophic gastritis or intestinal metaplasia may be offered periodic surveillance even after a negative test.

Common causes

  1. No infection

    The most likely explanation, particularly in people born in the US with no family history of ulcers or stomach cancer; around two-thirds of US adults are not infected.

  2. Recent proton-pump inhibitor use

    Omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole and dexlansoprazole taken within 14 days reduce the bacterial load and cause false negatives on breath, stool and biopsy tests. Vonoprazan does the same.

  3. Recent antibiotics or bismuth

    Any antibiotic course, or bismuth subsalicylate (Pepto-Bismol and similar), within the previous 4 weeks can suppress the bacterium without eradicating it.

  4. Recent upper gastrointestinal bleeding

    Blood in the stomach inhibits urease activity and reduces the sensitivity of the biopsy urease test and breath test; testing is repeated after recovery, or a blood test is used.

  5. Successful treatment

    A negative eradication test 4 or more weeks after treatment means the bacterium has been eradicated; reinfection afterwards is uncommon.

  6. Early infection or weak antibody response (blood test)

    IgG takes several weeks to become detectable, and some older or immunosuppressed people make little antibody, so the blood test misses about 15 percent of true infections.

  7. Sampling problems

    A watery or very small stool sample, a breath sample collected too early after the urea drink, or a biopsy taken from a patch of stomach the bacterium has vacated (common in atrophic gastritis) can all produce a false negative.

Symptoms that can go with it

  • None; a negative result is reassuring on its own
  • If upper abdominal pain, bloating or nausea continue, they are most often from functional dyspepsia or acid reflux rather than infection
  • Heartburn and regurgitation that worsen when lying flat point to gastroesophageal reflux
  • Pain after fatty meals, especially in the right upper abdomen, suggests gallstones
  • Persistent symptoms over age 60, weight loss, vomiting, difficulty swallowing, anemia or black stools still need endoscopy regardless of a negative H. pylori test

Read it alongside

  • Hemoglobin and ferritin — H. pylori is a recognized cause of unexplained iron deficiency anemia, and a bleeding ulcer lowers hemoglobin quickly.
  • Vitamin B12 — long-standing H. pylori gastritis reduces acid and intrinsic factor, lowering B12 absorption.
  • Platelet count — unexplained immune thrombocytopenia improves after eradication in a proportion of people, so H. pylori testing is part of its work-up.
  • CRP — usually normal with uncomplicated H. pylori; a high value with abdominal pain points to another process.
  • Lipase — raised in pancreatitis, which can mimic ulcer pain.
  • Tissue transglutaminase IgA — celiac disease is another cause of persistent dyspepsia and iron deficiency when H. pylori is negative.
  • Gastrin and pepsinogen — occasionally used to assess atrophic gastritis after long-standing infection.
  • Fecal occult blood or fecal immunochemical test — detects bleeding from an ulcer or a tumor.

What usually happens next

  1. If you are positive on a breath or stool test, expect a 10- to 14-day course of two or three antibiotics plus a strong acid suppressant; ask which regimen you are getting, take every dose, and report any previous antibiotic use (especially clarithromycin or levofloxacin), since prior exposure predicts resistance.
  2. If you are positive on a blood test only, ask for a breath or stool test to confirm active infection before treatment, unless you have a known ulcer or another clear reason to treat straight away.
  3. Book an eradication test (breath or stool, not blood) at least 4 weeks after the last antibiotic and 2 weeks after stopping any proton-pump inhibitor; if it is positive, a second course with different antibiotics is used, and a third failure usually prompts endoscopy with culture to guide the choice.
  4. If you are negative but symptoms continue, discuss a trial of acid suppression for reflux-type symptoms, a review of NSAID and aspirin use, celiac testing, and an endoscopy if you are over 60 or have any alarm feature.
  5. If an endoscopy found atrophic gastritis, intestinal metaplasia or an ulcer, ask whether follow-up endoscopy is recommended even after successful eradication.
  6. First-degree relatives of someone with stomach cancer, and people with a history of ulcer, MALT lymphoma or long-term NSAID or aspirin use, should be tested and treated even without symptoms.

Diet, lifestyle and natural levers with evidence

What can move H. pylori once the cause is known. Nothing here replaces finding the cause.

Probiotics alongside antibiotic treatment

Moderate evidence

Probiotics do not clear H. pylori on their own, but taken with eradication therapy they modestly raise its success and reduce side effects. A meta-analysis of 11 randomised trials found that adding Saccharomyces boulardii increased eradication from about 71 to 80 percent and roughly halved the rate of diarrhea; meta-analyses of Lactobacillus-containing products report a similar 8 to 13 percentage point gain, with fewer people stopping treatment early. Typical use is one to two doses a day, started with the antibiotics and continued for two to four weeks.

S. boulardii is a live yeast and has caused bloodstream infection in people with central venous catheters or severe immunosuppression; probiotics are not a substitute for completing the antibiotic course.

Broccoli sprouts (sulforaphane)

Preliminary evidence

In a small randomised trial, 70 g a day of sulforaphane-rich broccoli sprouts for 8 weeks lowered breath-test values and stool antigen levels by about 40 percent and reduced markers of gastritis, but no one was eradicated and the readings returned to baseline within two months of stopping. Sulforaphane suppresses the bacterium rather than clearing it; it has no role in place of antibiotics.

Cranberry

Preliminary evidence

Cranberry proanthocyanidins interfere with the bacterium's attachment to the stomach lining. In a randomised trial of over 500 infected adults in China, cranberry juice containing 44 mg of proanthocyanidins twice daily for 8 weeks produced a negative breath test in about 20 percent of people versus 13 percent with placebo, and an earlier trial found 14 percent versus 5 percent at 90 days. The effect is real but small; most people remain infected.

Cranberry juice is high in sugar and oxalate, and large amounts can increase the effect of warfarin.

Mastic gum

Preliminary evidence

Mastic resin from Pistacia lentiscus kills H. pylori in the laboratory. In a small randomised trial, 350 mg three times a day for 14 days produced a negative breath test five weeks later in about 30 percent of people, compared with none on placebo and about 77 percent with standard triple therapy. It is not a substitute for antibiotics, and larger trials are lacking.

Rare allergic reactions, particularly in people allergic to pistachio or cashew; do not use it to delay or replace recommended treatment.

Stop smoking during treatment and take the course exactly as prescribed

Moderate evidence

A meta-analysis of 22 studies found that smokers were almost twice as likely as non-smokers to fail eradication therapy, probably because smoking reduces gastric blood flow and mucus and may lower antibiotic concentrations in the stomach lining. Taking more than 90 percent of doses, and taking the acid suppressant before meals as directed, are the strongest predictors of success in trials; alcohol in moderation does not affect the result, though it worsens the metronidazole-related nausea some regimens cause.

When to see a clinician promptly

  • Vomiting blood or material that looks like coffee grounds, or passing black, tarry stools: a bleeding ulcer is an emergency and needs the emergency department now.
  • Sudden, severe abdominal pain with a rigid, tender abdomen, especially with fever or fainting: possible perforated ulcer, an emergency.
  • Upper abdominal symptoms with unintended weight loss, difficulty or pain swallowing, persistent vomiting, a lump in the abdomen or new iron deficiency anemia, at any age: alarm features that call for endoscopy rather than a breath test alone.
  • New indigestion symptoms starting after age 60, which guidelines say should be investigated with endoscopy.
  • A positive eradication test after two courses of treatment, to arrange endoscopy with culture or PCR so antibiotics can be matched to the bacterium's resistance pattern.
  • A positive test in someone with a first-degree relative who had stomach cancer, or a history of MALT lymphoma or gastric surgery, which may call for endoscopy and surveillance in addition to treatment.

Frequently asked questions

How do I prepare for an H. pylori breath test?

Stop proton-pump inhibitors (omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole, dexlansoprazole) for 2 weeks and avoid all antibiotics and bismuth products such as Pepto-Bismol for 4 weeks before the test. Do not eat or drink for at least 1 hour beforehand (many centers ask for 4 to 6 hours and for no smoking or gum). Antacids such as calcium carbonate are fine, and H2-blockers like famotidine are usually stopped only a day or two before. The test itself takes about 30 minutes.

Which H. pylori test is most accurate?

The urea breath test and the stool antigen test are both about 95 percent accurate for current infection when the medication rules are followed, and either can be used to confirm eradication after treatment. Biopsy tests at endoscopy are equally accurate and can show antibiotic resistance. The blood antibody test is the least useful: about 85 percent sensitive, 79 percent specific, and unable to distinguish current from past infection, so a positive blood test is normally confirmed with a breath or stool test before treatment.

What does a positive H. pylori test mean?

A positive breath or stool test means the bacterium is in your stomach now, and current guidelines recommend treatment for everyone who tests positive, because it heals and prevents ulcers and lowers lifelong stomach cancer risk by roughly a third to a half. A positive blood test means you have been infected at some time; in the US, a meaningful share of those are past infections, so it is usually confirmed with a breath or stool test first. A positive result does not mean you have an ulcer or cancer, only the bacterium that can cause them.

Can I take omeprazole before an H. pylori stool test?

No. Proton-pump inhibitors suppress the bacterium enough to produce a false-negative stool antigen or breath test in up to a third of infected people, so they should be stopped for 2 weeks beforehand. If stopping is not possible, for example because of severe reflux or a recent bleed, tell your clinician: an H2-blocker can be substituted for those two weeks, a blood test can be used as a rough screen, or testing can be done by biopsy at endoscopy with the limitation noted.

How long after treatment should I retest for H. pylori?

At least 4 weeks after your last antibiotic dose, and after at least 2 weeks off any proton-pump inhibitor, using a breath test or stool antigen test. Testing earlier can give a false negative because the bacterium is suppressed but not gone. Do not use the blood test for this; antibodies stay positive for a year or more after successful treatment. Everyone treated should have an eradication test, because about 10 to 20 percent of first courses fail and a second, different regimen is then needed.

Can H. pylori go away on its own or with natural remedies?

Spontaneous clearance in adults is rare; once established, the infection usually lasts for life without antibiotics. Broccoli sprouts, cranberry, mastic gum, green tea and various probiotics have each shown some suppression of the bacterium in small trials, but none reliably eradicates it, and readings rebound when they are stopped. The one well-supported adjunct is a probiotic taken alongside antibiotics, which raises success rates by around 8 to 13 percentage points and reduces side effects.

Does a positive H. pylori test mean I have an ulcer or cancer?

No. Most infected people have mild gastritis and no symptoms. Over a lifetime roughly 10 to 20 percent develop an ulcer and 1 to 2 percent develop stomach cancer, which is why treatment is recommended, but the test itself cannot show whether you have either. Alarm features such as bleeding, weight loss, difficulty swallowing, persistent vomiting, anemia or new symptoms after age 60 are the reasons for an endoscopy, which looks directly at the stomach lining.

Is the H. pylori breath test safe in pregnancy and for children?

The carbon-13 version uses a stable, non-radioactive isotope and is safe at any age and in pregnancy. The carbon-14 version uses a very small dose of a radioactive tracer, far below that of a chest X-ray, but is generally avoided in pregnancy and young children, for whom the stool antigen test is the usual choice. Treatment of asymptomatic infection is normally deferred until after pregnancy because of the antibiotics involved.

References

  1. Helicobacter pylori (H. pylori) tests. MedlinePlus, US National Library of Medicine (2023)View source
  2. Chey WD, Howden CW, Moss SF, et al.. ACG clinical guideline: treatment of Helicobacter pylori infection. American Journal of Gastroenterology (2024)
  3. Malfertheiner P, Megraud F, Rokkas T, et al.. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut (2022)
  4. Peptic ulcers (stomach or duodenal ulcers). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2022)View source
  5. Helicobacter pylori (H. pylori) infection. Mayo Clinic (2022)View source
  6. Hooi JKY, Lai WY, Ng WK, et al.. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology (2017)
  7. Ford AC, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis. Gut (2020)
  8. Gisbert JP, de la Morena F, Abraira V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. American Journal of Gastroenterology (2006)
  9. Szajewska H, Horvath A, Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii supplementation and eradication of Helicobacter pylori infection. Alimentary Pharmacology and Therapeutics (2015)
  10. Yanaka A, Fahey JW, Fukumoto A, et al.. Dietary sulforaphane-rich broccoli sprouts reduce colonization and attenuate gastritis in Helicobacter pylori-infected mice and humans. Cancer Prevention Research (2009)
  11. Suzuki T, Matsuo K, Ito H, et al.. Smoking increases the treatment failure for Helicobacter pylori eradication. American Journal of Medicine (2006)
  12. Helicobacter pylori infection. Merck Manual Professional Version (2024)

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