The evidence in support of the 2007 recommendation was substantive at that time and these broad recommendations are still pertinent. All patients with a new diagnosis or a past history of PUD should be tested for H. pylori infection. Ideally, tests which identify active infection such as a urea breath test, fecal antigen test, or when endoscopy is performed, mucosal biopsy-based testing should be utilized. Because of the higher pretest probability of infection, patients with documented PUD represent a rare group, where it is acceptable to utilize an IgG H. pylori antibody test. In most other circumstances where the pretest probability of infection is lower, tests which identify active disease are preferred over antibody testing. Patients with a history of PUD who have previously been treated for H. pylori infection should undergo eradication testing with a urea breath test or fecal antigen test. Patients with evidence of ongoing infection should be treated appropriately.