Do I need to test a patient's relatives for Helicobacter pylori (H. Pylori) infection after it was found in the patient?

Testing Relatives for H. Pylori After Index Patient Diagnosis

Yes, you should test family members residing in the same household as the patient with proven active H. pylori infection, as person-to-person transmission occurs within families and testing can protect other members from infection, reinfection, and H. pylori-related diseases. 1

Strength of Recommendation for Household Testing

The Houston Consensus Conference provides clear guidance on this issue with 91% agreement among experts that family members residing in the same household of patients with proven active H. pylori infections should be tested. 1 This recommendation is supported by moderate-level evidence. 1

Rationale for Testing Household Contacts

Transmission Dynamics

• H. pylori transmission occurs primarily through person-to-person contact, either via the oral-oral route (through vomitus or saliva) or the fecal-oral route. 2
• Intrafamilial clustering of H. pylori infection is well-documented, with higher incidence among family members living together. 2
• Humans are the principal reservoir for H. pylori, with no substantial reservoir existing outside the human stomach. 3

Prevention Benefits

• Testing and treating infected family members can protect other household members from initial infection or reinfection of the index patient. 1
• This approach may improve compliance with eradication treatment when family members understand their own infection status. 1
• Early detection and treatment prevents progression to serious complications including peptic ulcer disease and gastric cancer. 1

Additional High-Risk Relatives to Consider

Beyond household contacts, you should also consider testing relatives with:

• Family history of peptic ulcer disease (91% expert agreement, moderate evidence). 1
• Family history of gastric cancer (100% expert agreement, moderate evidence). 1

These relatives warrant testing even if they don't live in the same household, as familial clustering extends beyond just household transmission. 1

Practical Testing Approach for Asymptomatic Relatives

For asymptomatic family members, non-invasive testing is preferred:

• Urea breath test (UBT): Sensitivity 88-95%, specificity 95-100%. 4
• Stool antigen test: Laboratory-based validated monoclonal test with sensitivity and specificity >90%. 5
• Avoid serology: Cannot distinguish between active infection and past exposure, making it unsuitable for this purpose. 5

Common Pitfalls to Avoid

• Don't wait for symptoms: Asymptomatic relatives can still be infected and serve as transmission sources. 1
• Don't use rapid office serology tests: These have disappointing accuracy (sensitivity 63-97%, specificity 68-92%) and are not recommended. 1
• Ensure proper test preparation: Discontinue antibiotics and bismuth for at least 4 weeks, PPIs for at least 7 days (preferably 2 weeks), and ensure 6-hour fasting before testing. 4, 5

Special Populations Requiring Enhanced Vigilance

If your patient or their relatives belong to high-risk populations, testing becomes even more important:

• First-generation immigrants from high H. pylori prevalence countries (82% expert agreement). 1
• Latino and African American populations in the United States, where H. pylori prevalence is 2.6-3.2 fold higher than the general population. 1