When do you really consider treating ​H. pylori?​ Truly, many people will be H. pylori​ positive, [so] who [would] you treat?

It’s a good question. I’m going to be adding some content to the course about this because the research is evolving and the available testing is evolving. When I first created the ADAPT course, well, let me step back. So I think what the research is showing now is that treatment is [a] function of how much ​H. pylori​ is present, what’s the quantity, are there any virulence factors present, and how many? So virulence factors have been shown; if ​H. pylori​ is expressing virulence factors, that’s when it is truly pathogenic and needs to be treated, and it may not need to be treated if there are no virulence factors. And then antigen hosting are actions, and just that the general host, environment, and ecosystem, so the more compromised generally somebody is got to help the system, the more important [it] probably would be to treat ​H. pylori​ and then, of course, the presence of symptoms and signs. Did they have an ulcer? Did they have gastrointestinal bleeding? Are they at high risk for heart disease, which ​H. pylori ​has been connected to? Did they have a history of gastric cancer in their family, which ​H. pylori​ is connected to? So you have to really consider all those variables and make a clinical decision. At the time [when] I created this course, and even just with the most recent update, there wasn’t commercially available testing that allowed us to detect virulence factors, but there is now [with] the Diagnostic Solutions GI-MAP test, and that also is quantitative PCR [polymerase chain reaction], so it allows us to quantify how much ​H. pylori​ is there, so those are two important elements, and we’re going to be adding some content that explains how to use that kind of testing and what the decision-making process is there, but it involves all those factors that I mentioned. There’s no black or white algorithm that I use to determine whether treatment is necessary, but I take all that into consideration, and then it’s ultimately a judgment call.