Establishing a Consensus Algorithm for H. Pylori Screening, Diagnosis, Initial Management, and Referral Protocols for Primary Care Physicians

Sep 30, 2026

Uploaded by jayni

Helicobacter pylori (H. pylori) infection is a major public health issue in Africa, driving gastrointestinal disorders such as peptic ulcers and gastric cancer, while primary care clinicians still face diagnostic and treatment difficulties. This study developed a consensus-based management algorithm for primary care by integrating evidence from primary care physician screening data, patient testing using a rapid antibody test kit, and treatment decision inputs. A modified Delphi process produced a practical treatment and referral protocol.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

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Abstract

Background

Methodology

Results

Conclusion

Keywords

Introduction

Establishing a Consensus Algorithm for H . Pylori Screening, Diagnosis, Initial Management, and Referral Protocols for Primary Care Physicians. Sarah Abere1, Ozuomba Sixtus2, Ngozi Koko-James3. 1Gastroenterology Unit, Department of Internal Medicine, Rivers State University Teaching Hospital, Nigeria 2Department of Family Medicine Physician, General Hospital Lagos and Chairman, Society of Family Physicians of Nigeria, Lagos chapter, Nigeria, 3New Mile One Hospital, Port-Harcourt, Nigeria. Abstract Background: Helicobacter pylori (H. pylori) infection is a significant public health concern, contributing to various gastrointestinal disorders, including peptic ulcers and gastric cancer. The infection is highly prevalent in Africa, but still diagnostic and treatment challenges persist in primary care settings. Effective treatment regimens are therefore crucial for eradicating this infection and preventing complications. This study aimed to develop a consensus-based algorithm for H. pylori management optimized for Primary care settings utilizing data from primary care physicians, patient screening, and treatments. Methodology: A cross-sectional study was conducted among forty-four primary care physicians involved in diagnosing and treating H. pylori infection. They were provided with a data Collection Form (DCF) and an H. pylori rapid antibody test kit. All the questionnaire responses and the result of rapid antibody test were recorded and analyzed. A panel of experts involving senior family medicine doctors, and a gastroenterologist via a modified Delphi process of discussions on the DCF responses, and test results from the 44 physicians arrived at a consensus-based treatment algorithm developed to guide clinical decisionmaking for H. pylori management. Results: This study comprised 245 patients with a female preponderance and mean age of 35.0±11.5 years. The most common symptoms from the DCF were epigastric pain, nausea/vomiting and bloating in 74.5%, 52.7% and 35% respectively while the mean duration of symptoms was 3weeks. Constipation and irritability were the least common symptoms with heartburn reported less frequently in the H. Pylori positive cases. 79.9% of the 245 patients were H. Pylori treatment naïve with a higher likelihood (57.1%) of having a positive antibody test. It was recommended that both treatment experienced and naïve patients with epigastric or abdominal pain, nausea vomiting and/or bloating with symptom duration > 2weeks be tested and eradicated while those with alarm symptoms be referred to the specialist. Conclusion: The proposed algorithm provides a comprehensive guide for Physicians at the primary and secondary care level in selecting the most effective treatment regimen for H. pylori infection. H. Pylori antibody testing is a primary screening tool for patients with persistent symptoms or those lasting greater than 2weeks and where positive confirmatory test is recommended. Keywords: Consensus; Algorithm; H. Pylori; Clinical Guide; Primary Care. *Correspondence: Sarah Abere. Department of Internal Medicine, Rivers State University Teaching Hospital, Nigeria. Email: [sarah.abere@ust.edu.ng](sarah.abere@ust.edu.ng) . How to cite: Abere S, Sixtus O, Ngozi KJ. Establishing a consensus algorithm for H. pylori screening, diagnosis, initial management, and referral protocols for primary care physicians. Niger Med J 2025; 66 (4):1374-1385.[https://doi.org/10.71480/nmj.v66i4.789](https://doi.org/10.71480/nmj.v66i4.789) . Quick Response Code: Introduction Helicobacter pylori (H. pylori) is a spiral Gram-negative bacterium that inhabits the stomach lining, causes chronic gastritis and peptic ulcers, and is linked to gastric cancers such as adenocarcinoma and mucosal associated lymphoid tumor (MALT) lymphoma. Since its discovery in 1982 by Marshall and Warren, H. pylori is recognized as a major public health concern, with a global prevalence estimated to affect 50% of the populatio

FAQs

What problem does the study address regarding H. pylori in primary care?

The study targets diagnostic and treatment challenges faced by primary care settings for H. pylori infection, where effective eradication and prevention of complications are still difficult.

How was the consensus treatment algorithm developed?

A cross-sectional study enrolled forty-four primary care physicians, who completed a data collection form and underwent results recording from an H. pylori rapid antibody test kit. Expert discussions using a modified Delphi process combined the DCF responses and test results to reach consensus on a treatment algorithm.

What testing and treatment pathway does the proposed algorithm recommend?

Patients with epigastric or abdominal pain, nausea/vomiting and/or bloating with symptom duration greater than two weeks should be tested and eradicated if appropriate, while patients with alarm symptoms should be referred to specialists. H. pylori antibody testing is positioned as a primary screening tool for persistent symptoms.

Sep 30, 2026

Uploaded by jayni