Routine screening for Helicobacter pylori infection with urea breath testing during hospitalization for myocardial infarction (MI) does not reduce the risk of upper gastrointestinal bleeding in unselected patients with MI, according to findings from the HELP-MI SWEDEHEART trial presented at the ESC Congress 2025. However, secondary and subgroup analyses suggest a potential clinically meaningful benefit of H. pylori screening in settings with a high prevalence of H. pylori infection or lower proton pump inhibitor use, and in patients with a high risk of bleeding at baseline.

The trial included 18,466 patients with MI from 35 Swedish hospitals. The hospitals were grouped into clusters and randomly assigned to a sequence of 1 year of routine H. pylori screening of all patients with acute MI followed by a 2-month washout period and 1 year of usual care, or vice versa. In the screening periods, 70% of patients underwent testing and, of these, 23.6% tested positive for H. pylori, which meant that they had an active infection. Among the patients who tested positive, 96.6% received H. pylori eradication therapy as recommended by the treating physician.