Should Helicobacter pylori (H. pylori) testing be performed due to close family contact with a known H. pylori positive individual?

H. pylori Testing in Close Family Contacts

H. pylori testing should be performed for individuals with close family contact to a known H. pylori positive individual, as household family members with active H. pylori infection represent a recognized risk factor for transmission and subsequent disease development. 1

Rationale for Testing Family Contacts

• H. pylori infection is primarily transmitted from person to person through oral-oral or fecal-oral routes
• Family clustering of H. pylori infection is well-documented, with higher rates of infection among household members
• Early detection and eradication can prevent serious complications including:
  • Peptic ulcer disease
  • Gastric cancer
  • MALT lymphoma

Risk Assessment for Family Contacts

The risk of H. pylori transmission is increased in:

• Household family members with close contact 1
• Crowded or high-density living conditions 2
• Settings with inadequate sanitation practices 2
• Families sharing meals and utensils

Testing Recommendations

For asymptomatic family contacts of H. pylori positive individuals:

• First-line test: 13C-Urea Breath Test (UBT) - non-invasive gold standard with 97% sensitivity 3
• Alternative: Validated laboratory stool antigen test
• Avoid serology: Not recommended for initial testing as antibody titers can remain positive for months after eradication 3

Special Considerations

• Testing should be performed at least 2 weeks after discontinuation of PPIs to avoid false negatives 3
• For children in the household, age-appropriate testing should be considered
• If the family member has symptoms suggestive of upper GI pathology, endoscopy with biopsy may be warranted

Management After Testing

If H. pylori positive:

1. Treat according to local antibiotic resistance patterns:

   • In areas with high clarithromycin resistance (≥15%): 14-day bismuth quadruple therapy or 14-day concomitant therapy 1
   • In areas with low clarithromycin resistance (<15%): 14-day triple therapy or 14-day bismuth quadruple therapy 1

2. Confirm eradication with 13C-UBT at least 4 weeks after completion of treatment 3

3. Consider testing other household members if one family contact tests positive

Public Health Implications

• Testing and treating family contacts may reduce the reservoir of infection within households
• This approach could potentially reduce H. pylori-related disease burden, particularly in high-prevalence populations
• Family-based testing strategies align with efforts to reduce gastric cancer incidence through H. pylori eradication 4

Common Pitfalls to Avoid

• Failing to wait an adequate period after PPI use before testing (can cause false negatives)
• Not confirming eradication after treatment
• Overlooking the importance of treating all infected household members to prevent reinfection
• Using serology as a test of cure (antibodies may persist for months)

By implementing systematic testing of close family contacts of H. pylori positive individuals, clinicians can help break the cycle of transmission and reduce the long-term risk of H. pylori-associated diseases.