If your father, mother, sister, brother or child has had stomach cancer, ask your doctor for a Helicobacter pylori test and treat it if positive. In a trial, treating this germ in first-degree relatives of patients cut the risk of stomach cancer by more than half [2]. The international Maastricht VI consensus says everyone who is infected should be treated [3], and a test to confirm eradication is needed after treatment [5].
One important step: get tested, and treat it if positive
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Should you be tested?
Especially if a first-degree relative (father, mother, sister, brother or child) has had stomach cancer [2], or if you have indigestion or a stomach ulcer. Ask your doctor.
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The test is simple
It is usually a breath test or a stool test, and sometimes done during endoscopy [3]. Your doctor chooses the right method.
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When should you see a doctor straight away?
The H. pylori test is for prevention. If you have unexplained weight loss, difficulty swallowing, repeated vomiting, vomiting blood, black stools or anaemia [4], the test is not enough and a doctor should decide about endoscopy. See the signs in symptoms of stomach cancer (Persian).
Frequently asked questions
If I have H. pylori, does that mean I will get cancer?
I have no symptoms. Do I still need treatment?
Should my family be tested too?
If there is stomach cancer in the family, it makes sense to discuss H. pylori testing for first-degree relatives (sisters, brothers, children) [2].
Notes for doctors (for physicians)
For physicians
Evidence. In the double-blind randomised trial by Choi et al. (South Korea), 1,838 H. pylori-infected first-degree relatives of patients with gastric cancer received 7-day triple therapy or placebo. At a median follow-up of 9.2 years, gastric cancer occurred in 1.2% vs 2.7% (HR 0.45; 95% CI 0.21 to 0.94), and in 0.8% with successful eradication vs 2.9% with persistent infection [2].
Choice of regimen. ACG 2024 guideline: in treatment-naive patients when antibiotic susceptibility is unknown, 14-day bismuth quadruple therapy is the preferred regimen; clarithromycin- or levofloxacin-containing regimens only with confirmed susceptibility. A test of eradication is recommended for all patients after treatment [5]. Maastricht VI also stresses the role of antibiotic resistance in choosing a regimen [3]. Dose details are in the full ACG guideline.
First-line regimen (ACG 2024 guideline). Bismuth quadruple therapy for 14 days: a proton pump inhibitor twice daily, tetracycline 500 mg four times daily, metronidazole 500 mg three or four times daily and bismuth (subcitrate or subsalicylate) four times daily [5]. Do not substitute doxycycline for tetracycline, because it lowers eradication rates [5]. Confirm eradication with a urea breath test or stool antigen test at least 4 weeks after the end of treatment [3, 5].
Scientific evidence
Related cancer types
Related questions
References
5 referencesShow all references, 3 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 4Gastric cancer
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This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
