Description

Postal Diagnostic Test — NICE & Maastricht VI Aligned

HBAG Stool Antigen Test for Helicobacter pylori

A laboratory-confirmed postal stool antigen test for H. pylori infection — the non-invasive method recommended by NICE and the Maastricht VI/Florence Consensus, with monoclonal stool antigen testing shown to achieve 94–95% sensitivity and 97–98.6% specificity in published clinical studies.

✔ Results in approximately one week  |  ✔ Prepaid return envelope included  |  ✔ NICE-recommended test method

What is Helicobacter pylori?

Helicobacter pylori (H. pylori) is a gram-negative, spiral-shaped bacterium that colonises the gastric mucosa, causing persistent infection in the stomach lining. It is one of the most prevalent chronic bacterial infections worldwide, affecting an estimated half of the global population.

In the UK, H. pylori is estimated to affect up to 1 in 5 people, with some estimates suggesting infection in up to 40% of the population, depending on age and demographic group. Most infections are acquired in childhood, and prevalence tends to be higher in older age groups and in those who grew up in households with overcrowding or limited sanitation.

H. pylori is classified as a Group 1 carcinogen by the World Health Organisation’s International Agency for Research on Cancer (IARC) and is the leading cause of peptic ulcer disease — responsible for up to 90% of duodenal ulcers and 80% of gastric ulcers. Early detection and eradication are strongly recommended by NICE and international consensus guidelines, as effective treatment has been shown to reduce long-term gastric cancer risk.

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Bacterial Infection

H. pylori survives in the acidic environment of the stomach using the enzyme urease, and damages the protective mucosal lining.

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How It Spreads

Transmission most commonly occurs person-to-person via the faecal–oral or oral–oral route, often within households via food preparation, saliva, or contaminated water.

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Group 1 Carcinogen

Recognised by the WHO/IARC as a leading risk factor for gastric cancer and peptic ulcer disease. Eradication significantly reduces this risk.

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Treatable

Standard 7-day twice-daily triple therapy (PPI + two antibiotics) achieves high eradication rates, in line with NICE CG184 guidance.

Why a Stool Antigen Test? The Clinical Evidence

There are several methods for detecting H. pylori: breath testing, blood serology, stool antigen testing, and invasive endoscopic biopsy. NICE guideline CG184 specifically recommends stool antigen testing or carbon-13 urea breath testing as the preferred non-invasive methods — and explicitly advises against office-based blood serology testing due to its inadequate diagnostic performance.

Stool Antigen Test (this test)

A systematic review of 22 studies (2,499 patients) found monoclonal stool antigen tests achieve 94–95% sensitivity and 97–98.6% specificity — detecting active current infection by identifying H. pylori antigen proteins directly in the stool. NICE-recommended.

Blood Serology Test

Detects antibodies, not active infection — cannot distinguish a current infection from a past, already-treated one. NICE specifically advises against routine office-based serology due to its lower specificity and higher false-positive rate.

Urea Breath Test

Comparable accuracy to stool antigen testing, but requires specialist equipment, is more expensive, and is harder to perform reliably at home or in children — making stool antigen testing the more practical postal option.

In practical terms: using a stool antigen test in a typical UK dyspepsia population (where roughly 25% of patients test positive), only around 3% of patients receive unnecessary antibiotic treatment due to a false result. By contrast, the older serology-based blood test produces roughly four times more false positives, leading to unnecessary antibiotic exposure and antimicrobial resistance risk. This is why our test uses the stool antigen method — the gold-standard non-invasive approach for active infection.

Symptoms of H. pylori Infection

Symptoms can vary considerably. Many people carry the infection without any noticeable symptoms, which is why testing is important even for mild or non-specific digestive complaints. When symptoms do occur, they may include:

  • A persistent burning or gnawing sensation in the stomach (heartburn)
  • Acid reflux or regurgitation
  • Nausea or vomiting
  • Unusual increase in appetite or hunger
  • Bloating and excessive flatulence
  • Unintentional weight loss
  • Dark or tarry stools (indicating gastrointestinal bleeding — seek urgent medical attention)

Important: Some people experience no symptoms at all, yet the infection is still present and causing damage. Around 90% of patients with duodenal ulcer and 80% with gastric ulcer are infected with H. pylori, and symptoms often do not respond to over-the-counter medication or proton pump inhibitors alone. Testing is the only way to confirm or exclude infection as the underlying cause.

🔮 H. pylori and Chronic Spontaneous Urticaria (Hives)

H. pylori infection has been associated with increased mast cell reactivity and may act as a co-factor in worsening or perpetuating chronic spontaneous urticaria (CSU). In patients with persistent hives lasting more than six weeks, testing for and eradicating H. pylori is recommended as part of a thorough investigation, as successful treatment may improve or resolve urticaria symptoms in a subset of patients.

Who Should Consider Testing?

NICE’s “test and treat” strategy recommends H. pylori testing for people with dyspepsia (recurrent epigastric pain, heartburn, or acid regurgitation, with or without bloating, nausea, or vomiting) who have not responded to initial management. You may wish to consider testing if you:

  • Have persistent indigestion, heartburn, or stomach pain not relieved by over-the-counter antacids
  • Have a family history of peptic ulcer disease, gastric cancer, or known H. pylori infection (it commonly spreads within households)
  • Have chronic spontaneous urticaria (hives) lasting more than six weeks with no clear cause
  • Are experiencing iron-deficiency anaemia without an obvious cause
  • Have completed eradication treatment previously and need confirmatory re-testing
  • Want a private alternative to a lengthy GP referral pathway

If you are over 45 or have “alarm” symptoms — unexplained weight loss, difficulty swallowing, vomiting blood, or black/tarry stools — NICE guidance recommends referral for endoscopy to exclude gastric malignancy rather than relying on a stool test alone. Please see your GP urgently if any of these apply to you.

Why Eradication Matters: Clinical Guidelines

Because H. pylori is a recognised carcinogen and a principal cause of peptic ulcer disease, both NICE guideline CG184 (UK) and the Maastricht VI/Florence Consensus (European) recommend:

  • Test and treat all patients with confirmed H. pylori infection and dyspeptic symptoms
  • Complete the full 7-day, twice-daily course of antibiotic eradication therapy (typically a PPI with clarithromycin and either amoxicillin or metronidazole, or alternative regimens for those with penicillin allergy)
  • Leave a 2-week washout period after stopping proton pump inhibitor (PPI) use before testing or re-testing
  • Perform a confirmatory re-test at least four weeks after completing treatment using a carbon-13 urea breath test or repeat stool antigen test to verify successful eradication, particularly in those at increased gastric cancer risk

If your result is positive, please book an appointment with one of our specialist consultants or your GP to arrange appropriate treatment and follow-up. Untreated H. pylori infection does not resolve on its own and antibiotic resistance is increasing globally, so prompt, guideline-concordant treatment matters.

🖕 If Your Result is Positive

Do not ignore a positive result. H. pylori does not clear on its own without antibiotic treatment. Please:

  • Book an appointment with one of our consultants or your GP as soon as possible
  • Begin the prescribed eradication course and complete it in full, even if symptoms improve early
  • Arrange a repeat confirmatory test at least four weeks after completing treatment (and at least two weeks after stopping any PPI medication)

How the Postal Stool Test Works

1

Order Your Test

Complete your order. This test must be ordered on its own — please do not add any other tests in the same transaction.

2

Receive Your Kit by Post

You will receive a stool collection pot, a laboratory request form, and a prepaid return envelope — everything you need is included.

3

Label the Pot — Before You Collect

Write your full name and date of birth clearly on the stool pot before collecting your sample. This step is essential for laboratory processing.

4

Collect Your Sample

Follow the simple instructions provided with your kit to collect a small stool sample into the labelled pot.

5

Post Everything Back to the Laboratory

Place the labelled stool pot and the laboratory request form in the prepaid envelope and post it back. Please include all items received in the kit.

6

Receive Your Results

Results are typically available within approximately one week of the laboratory receiving your sample. You will be notified via your preferred contact method through your secure online portal.

Understanding Your Result

Negative

No H. pylori antigen detected. Active infection is unlikely. If symptoms persist, discuss other possible causes with your GP.

Positive

H. pylori antigen detected — active current infection confirmed. Eradication treatment should be arranged with a GP or specialist.

Borderline

Some antigen detected, but below a clear positive threshold. Re-testing or clinical correlation is usually recommended.

⚠️ Important Reminders Before You Post

  • Write your full name and date of birth on the stool pot before collecting your sample
  • Include the laboratory request form — do not discard it
  • Use the prepaid return envelope provided
  • Post all items received: pot + laboratory form + envelope
  • Order this test on its own — do not add other tests in the same checkout transaction
  • Stop PPI medication (e.g. omeprazole, lansoprazole) at least 2 weeks before testing, and antibiotics or bismuth compounds at least 4 weeks before testing, to avoid a false-negative result — check with your prescriber first

Frequently Asked Questions

How accurate is this test?

Monoclonal stool antigen testing — the method used in this test — has been shown in a systematic review of 22 studies (2,499 patients) to achieve approximately 94–95% sensitivity and 97–98.6% specificity. This means the test correctly identifies the vast majority of true infections while keeping false positives low, and is the non-invasive method explicitly recommended by NICE.

Do I need to prepare for the test?

You should not have taken any antibiotics or bismuth-containing medication for at least four weeks before the test, and should ideally stop proton pump inhibitors (PPIs) such as omeprazole at least two weeks prior, as these can suppress bacterial load below the test’s detection threshold and produce false-negative results. Please check with your prescriber before stopping any regular medication.

Why can this test only be ordered on its own?

The stool antigen test requires its own dedicated laboratory kit and return logistics. Adding other tests in the same order can cause processing errors. Please complete a separate transaction for this test.

How soon will I receive the test kit?

Kits are typically dispatched within 1–2 working days and delivered by Royal Mail. Please allow 2–5 working days for delivery.

Why is a stool antigen test better than a blood test for H. pylori?

A blood (serology) test detects antibodies, which remain in the bloodstream long after an infection has been successfully treated. This means a blood test cannot reliably distinguish between a current, active infection and a past one that has already cleared. NICE guidance specifically advises against routine office-based serology for this reason. A stool antigen test detects the bacterium’s actual proteins in your stool, confirming active, current infection — making it far more clinically useful for both diagnosis and treatment decisions.

What happens after a positive result?

You will need antibiotic eradication therapy prescribed by a GP or specialist — typically a 7-day course combining a PPI with two antibiotics (commonly clarithromycin with amoxicillin or metronidazole), in line with NICE guidance. After completing the course, a confirmatory repeat test is recommended at least four weeks post-treatment (and two weeks after stopping any PPI) to confirm eradication.

Can H. pylori come back after treatment?

Once successfully eradicated, reinfection is uncommon in adults in the UK. If symptoms return after confirmed successful treatment, this is more likely to indicate a different underlying cause, and you should discuss this with your GP rather than assuming reinfection.

Is this test suitable for children?

Yes, this test can be done for both adults and children.

Please note: This test is intended for patients aged 18 and over; please contact us before ordering for a child. Results are provided for informational purposes and should be interpreted in the context of your clinical history by a qualified healthcare professional. A positive result does not constitute a diagnosis in isolation. If you are over 45, or are experiencing severe symptoms such as black or tarry stools, vomiting blood, difficulty swallowing, or unexplained weight loss, please seek urgent medical attention rather than waiting for test results, as these may warrant endoscopic investigation in line with NICE guidance.