Helicobacter Pylori and Endoscopy: Diagnosis and Eradication
Diagnosis · Endoscopy Silo · Colombia 2026
Helicobacter pylori and endoscopy: diagnosis, biopsies, and eradication protocol
Colombia has one of the highest H. pylori prevalences in the world — endoscopy with biopsies is the diagnostic gold standard and the only method that also identifies associated gastric lesions. Complete 2026 guide
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GSMED Imaging medical team — diagnostic endoscopy Colombia
Based on: Colombian Society of Gastroenterology Clinical Practice Guidelines for H. pylori 2024, ESGE/EHMSG Kyoto Global Consensus (Malfertheiner 2022), European Registry on H. pylori (Hp-EuReg 2024) and INC Colombia prevalence statistics.
Colombia has a Helicobacter pylori prevalence of 65–70% in the adult population — one of the highest in Latin America — and this bacterium is the most important type I carcinogen for gastric cancer. Endoscopy with biopsies is the only method that simultaneously diagnoses the infection, evaluates gastric mucosal damage (atrophic gastritis, intestinal metaplasia) and obtains tissue for histology — information that no non-invasive test can provide.
1. Why Colombia has such a high H. pylori prevalence
65–70%
H. pylori prevalence in the Colombian adult population — 2nd highest in Latin America
2nd
Colombia: second country in AL with the highest gastric cancer mortality (INC 2025)
CagA+
Virulent strains (CagA positive) predominant in Colombia — higher cancer risk
WHO
H. pylori declared a Type I (definitive) carcinogen by the IARC/WHO since 1994
2. How H. pylori is diagnosed in endoscopy
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Rapid urease test (CLO test)
The gastric biopsy is placed in a medium with urea and a pH indicator. If H. pylori is present, its urease breaks down the urea, releasing ammonia — the pH rises and the indicator changes color (positive in 1–24 hours). Sensitivity 85–95%, specificity 95–100%. The fastest and most affordable test. Its sensitivity decreases if the patient recently took a PPI.
→ 1–24 h · Affordable · Low sensitivity with recent PPI
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Culture (resistance gold standard)
The gastric biopsy is cultured in specific media. It allows identifying H. pylori and performing an antibiogram to detect antibiotic resistance — critical given the increase in clarithromycin and metronidazole resistance in Colombia. Slower (7–14 days) and more expensive technique, but indispensable when there are repeated eradication failures.
→ Antibiogram · Resistances · 7–14 days · Eradication failures
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Histology (Sydney protocol)
Giemsa or Warthin-Starry staining in the Sydney protocol biopsies (5 systematic biopsies: antrum × 2, incisura, body × 2) detects H. pylori directly and also stages chronic gastritis (OLGA/OLGIM system) — cancer risk prognostic information that no other method provides.
→ Sydney Protocol · OLGA/OLGIM · Cancer risk staging
3. LCI and NBI for H. pylori — enhanced imaging changes the diagnosis
Fujifilm LCI (Linked Color Imaging) — the only specific H. pylori imaging technology
LCI (Fujifilm ELUXEO exclusive technology) was designed specifically to improve the detection of H. pylori gastritis. Mucosa infected by H. pylori shows a very subtle irregular erythema pattern in conventional white light — almost invisible to the trained eye. LCI amplifies those color differences and makes visible the regular erythema patterns of the normal antrum (H. pylori negative) vs the irregular nodular erythema of the infected antrum. Japanese studies from 2022–2024 (Ono et al.) show 87% sensitivity for active H. pylori diagnosis with LCI imaging alone — without the need for a biopsy. However, ESGE 2023 continues to recommend biopsy as confirmation — imaging alone is not sufficient to indicate treatment.
4. First-line eradication in Colombia 2026
| Regimen | Drugs | Duration | Eradication rate Colombia |
|---|---|---|---|
| Bismuth quadruple therapy (recommended 1st line) | PPI + bismuth + metronidazole + tetracycline | 10–14 days | 85–90% — superior to triple therapy with clarithromycin |
| PPI + amoxicillin + clarithromycin + metronidazole | 10–14 days | 80–88% — valid if clarithromycin resistance <15% | |
| PPI + amoxicillin + clarithromycin | 14 days | 65–75% — increasingly less effective due to growing resistances in Colombia |
Should PPIs be stopped before endoscopy to diagnose H. pylori?
Yes, ideally. Proton pump inhibitors (omeprazole, esomeprazole, pantoprazole) suppress H. pylori growth and reduce its density in the mucosa, which can produce false negatives in the rapid urease test and histology. Guidelines recommend stopping PPIs at least 2 weeks before diagnostic endoscopy when the main goal is to diagnose H. pylori. If the patient cannot stop them (severe GERD, active ulcer), culture and PCR should be done, which are less sensitive to PPIs, and the doctor should be informed that they took them to interpret the results with that limitation.
Fujifilm ELUXEO systems with LCI available in Colombia — GSMED
The only system with LCI for H. pylori imaging diagnosis — Fujifilm distributors in Colombia with local technical support.
Related articles
Sources
- SCG. H. pylori Colombia Clinical Practice Guideline. gastrocol.com. 2024. Prevalence, regimens. Colombia SCG 2024
- Malfertheiner P et al. Kyoto Global Consensus — H. pylori. Gut. 2022. Kyoto 2022
- Ono S et al. LCI for H. pylori detection. J Gastroenterol. 2022. LCI sensitivity 87%. Ono 2022
- INC Colombia. Atlas of gastric cancer mortality. cancer.gov.co. 2025. Colombia
