H. pylori test in Seoul: test, treat, retest

Why get an H. pylori test in Seoul

H. pylori is a bacterium that lives in the stomach lining. It is usually picked up in childhood and can persist for decades without symptoms. In some people it causes gastritis, stomach or duodenal ulcers and, over many years, raises the risk of gastric cancer and a type of stomach lymphoma.

Korea has historically had a high prevalence of H. pylori, and gastric cancer is among the more common cancers in the country, which is why Korea runs national endoscopy screening. Getting an H. pylori test in Seoul makes sense if you have upper-abdominal symptoms, a history of ulcers, a family history of gastric cancer, or a checkup endoscopy that suggested infection.

Breath, stool or blood: which test

If you are over a certain age, have alarm symptoms or need biopsies, endoscopy is the better route. VEI Clinic does not perform endoscopy, but we can refer you to a hospital and then manage treatment and retesting with you.

• Urea breath test: you drink a labeled urea solution and breathe into a bag. Highly accurate for active infection and the preferred test to confirm eradication.
• Stool antigen test: detects H. pylori proteins in a stool sample. Also accurate for active infection and useful for retesting.
• Blood antibody test: shows past or present exposure. It can stay positive for months or years after successful treatment, so it cannot confirm eradication. Useful mainly as an initial screen in some situations.

How to prepare

Some medicines suppress the bacteria temporarily and cause false negative breath and stool results. Unless your doctor says otherwise:

• Stop proton pump inhibitors (such as omeprazole, esomeprazole, lansoprazole or pantoprazole) and potassium-competitive acid blockers widely used in Korea (such as tegoprazan or fexuprazan) for 2 weeks before testing.
• Avoid antibiotics and bismuth products for 4 weeks before testing.
• Fast for about 4–6 hours before a breath test.
• Antacids are usually acceptable for symptom relief while you wait. Blood antibody tests do not need these steps.
• Never stop a medicine that was prescribed for bleeding or a serious ulcer without asking your doctor first.

Eradication therapy and retesting

If you test positive, treatment usually combines an acid-suppressing drug with two or more antibiotics, sometimes with bismuth, for 10 to 14 days. Clarithromycin resistance is common in Korea, so the regimen is chosen with local resistance in mind. Common side effects include a metallic taste, nausea, loose stools and, with metronidazole, a strong reaction to alcohol, so avoid drinking during treatment.

Finishing every dose matters. Retesting by breath or stool test should be done at least 4 weeks after finishing antibiotics, and with PPIs stopped for 2 weeks before. If the first treatment fails, a different regimen is used. Family members may be tested if they have symptoms or risk factors.

Who should be tested, and who may not need it

Testing is generally recommended for people with active or past peptic ulcers, ongoing indigestion or upper-abdominal discomfort, a first-degree relative with gastric cancer, unexplained iron-deficiency anemia, a type of stomach lymphoma called MALT lymphoma, or before long-term aspirin or anti-inflammatory use in higher-risk people. Many Koreans are also told about possible infection after a routine checkup endoscopy.

Testing people without symptoms or risk factors is a more individual decision. If you would be unable or unwilling to take a course of antibiotics, it is worth discussing that before testing. People with penicillin allergy can still be treated, but the regimen is different, so tell us about any drug allergies in advance.

Red flags and who should go straight to endoscopy

A breath or stool test alone is not enough if you have difficulty swallowing, persistent vomiting, unintended weight loss, iron-deficiency anemia, a feeling of fullness after small meals or a strong family history of gastric cancer. These need endoscopy, and we can arrange a hospital referral.

Go to an ER or call 119 in Korea if you vomit blood or material that looks like coffee grounds, pass black or tarry stools, have sudden severe upper-abdominal pain, or feel faint or lightheaded. These can signal a bleeding or perforated ulcer.