Maastricht VI / Florence 2022 (Malfertheiner Gut) is the international consensus that frames almost every H. pylori workflow now. It re-asserted the test-and-treat strategy for uninvestigated dyspepsia under age 60 without alarm symptoms, and tightened the indications for routine testing.
Who gets tested
- All adults with uninvestigated dyspepsia (test-and-treat first)
- Peptic ulcer disease (active or history)
- MALT lymphoma
- Long-term NSAID users at high risk of ulcer
- First-degree relatives of gastric cancer patients
- Unexplained iron-deficiency anemia or ITP after excluding other causes
Test choice
The choice depends on whether you need to confirm active infection or just any exposure. Urea breath test (UBT) and stool antigen are the gold standards for active infection — both are 95%+ sensitive and specific, and both turn negative after successful eradication.
Serology (H. pylori IgG/IgA/IgM) detects past or current exposure and can stay positive for 6-12 months after eradication. It is therefore the wrong test for confirming cure, but it has real value in three situations:
- GastroPanel context — pair with Pepsinogen I + II + Gastrin-17 to stratify atrophy risk non-endoscopically.
- Recent antibiotic or PPI use — breath test and stool antigen become falsely negative; serology is unaffected.
- Severe GI bleed — when the patient cannot be off PPI long enough for breath/stool testing.
Eradication therapy
Maastricht VI recommends bismuth quadruple (PPI + bismuth + metronidazole + tetracycline) as first-line in most regions due to rising clarithromycin resistance. In areas where clarithromycin resistance is <15%, the legacy triple therapy (PPI + clarithromycin + amoxicillin) remains acceptable. Always confirm eradication with UBT or stool antigen at least 4 weeks post-therapy and 2 weeks off PPI.
What to stock in your lab
The MME Gastric panel covers the serological + GastroPanel angle: H. pylori IgA / IgG / IgM (Maglumi + Alegria options), Pepsinogen I + II, and Gastrin-17. Pair with EGD + Sydney biopsy referral for OLGA / OLGIM staging in high-risk patients per ESGE 2019.