Should family members be tested for Helicobacter pylori (H. pylori) if one is infected?

Testing Family Members for Helicobacter pylori When One Member is Infected

Yes, family members should be tested for Helicobacter pylori when one member is infected, as recommended by current guidelines with moderate evidence support. 1

Rationale for Family Testing

H. pylori infection tends to cluster within families due to person-to-person transmission. This familial clustering has important clinical implications:

• The 2022 Annual Review of Medicine guideline specifically recommends testing family members residing in the same household of patients with proven active H. pylori infections (91% agreement, moderate evidence level) 1
• H. pylori is typically acquired in childhood, especially through transmission within families 1
• Family clustering contributes to the increased risk of peptic ulcer disease and gastric cancer within families 1

Testing Approach for Family Members

When one family member is diagnosed with H. pylori:

1. Who to test:

   • All family members residing in the same household 1
   • Priority for first-degree relatives (parents, siblings, children)
   • Special attention to children, as infection is often acquired in childhood 2

2. Testing methods:

   • Non-invasive tests are recommended for asymptomatic family members:
     • 13C-Urea Breath Test (UBT) - detects active infection 1, 3
     • Laboratory-validated serology - acceptable if locally validated 1, 3
     • Stool antigen test - detects active infection 3

3. When to refer for endoscopy:

   • Family members over 45 years with dyspeptic symptoms 1
   • Any family member with alarm symptoms (anemia, weight loss, dysphagia, palpable mass) 1
   • Family members with a personal history of gastric ulcer 1

Benefits of Family Testing and Treatment

Testing and treating all infected family members provides several important benefits:

• Prevents reinfection of the index patient after successful treatment 1
• Reduces transmission to other family members 1
• Engages those who test positive to comply with eradication treatment 1
• Reduces the risk of H. pylori-related diseases in all family members 1
• Family-based treatment approach results in higher eradication rates (94% vs 75% when only treating the index case) 4
• Reduces the risk of gastric cancer in family members with a family history of gastric cancer 5

Special Considerations

• Children under 5 years: May be at higher risk for reinfection after treatment; current recommendations don't advise treatment unless an ulcer or gastric atrophy is present 2
• Family history of gastric cancer: These individuals should be prioritized for testing and treatment, as H. pylori eradication significantly reduces gastric cancer risk in this high-risk group 1, 5
• High-risk populations: First-generation immigrants from high-prevalence countries and certain racial/ethnic groups (e.g., Latino, African American, East Asian in the US) have higher H. pylori prevalence and should be considered for testing 1

Pitfalls to Avoid

• Incomplete family testing: Testing only the symptomatic individual without addressing potential family reservoirs may lead to reinfection after successful treatment
• Using non-validated rapid serological tests: These have shown disappointing sensitivity and specificity (63-97% and 68-92%, respectively) 1
• Ignoring family history of gastric cancer: This is a critical risk factor that warrants aggressive testing and treatment 1, 5
• Poor compliance with treatment: Multiple drugs, frequent dosing, and length of treatment can contribute to poor compliance; ensure all family members understand the importance of completing the full course 2

By testing and treating all infected family members when one is diagnosed with H. pylori, you can effectively break the cycle of transmission within the household and reduce the risk of serious H. pylori-related diseases for the entire family.