Karisma Mulji, pharmacist at Vitality Pharmacy in Leicester, talks to Saša Janković about running an H. pylori testing service.

Service type: Heliobacter pylori breath testing

Name and location of pharmacy: Vitality Pharmacy, Leicester

Name of pharmacist: Karisma Mulji

Why did you start offering this service? To help share the load with the GPs - as a commissioned service (for people aged 18 and over) it is really accessible for patients. We started offering the service over five years ago.

How much did it cost to set up the service?

Not a lot. We order the test kits from AAH, but the service fee we receive covers the cost.

What, if any, training did you or other team members have to undergo?

I read the service specification that was provided, and I’d also had some experience during my pre-reg year – I observed a colleague conducting the test and when we had another patient my colleague got me to do it and observed me.

In a nutshell, what does the service involve?

H. pylori bacteria enters the body through food – such as processed meat or foods that haven’t been cooked properly - and drink. Although the infection doesn’t always cause problems, if left untreated the person will stay infected for life, and some people develop stomach ulcers.

People with suspected H. pylori infection are referred to us by their GP, and once they get in touch, we can arrange the appointment accordingly. We start with some screening questions because if, for example, they have taken antibiotics in the previous four weeks we need to delay the test. If they’ve already been put on PPI medication to deal with stomach discomfort they need to stop for a two-week gap, and if they are taking H2-receptor antagonists they need a gap of four days before we can do the H. pylori test.

Once we’ve explained all of that, we arrange a time with them for the appointment. We like to do it early in the morning at our pharmacy as it also requires fasting for six hours prior to the test, but some of our patients work night shifts and are not free until later in the day, so we will fit them in at a time that suits them.

The test itself only takes about 15-20 minutes. The test kit has four test tubes (two blue, two red) and a tablet. The person takes a deep breath and blows out through a straw into one blue tube with one strong breath, and then again into the second blue tube. Next they take the tablet, and exactly ten minutes after they repeat the breath into both of the red tubes.

We send the completed kit off to the lab, and when the results come back – in 5-7 working days – we let the patient and the surgery know. If the results are positive, we refer the person back to their GP who will prescribe a one-week treatment course of three medicines: two antibiotics and a PPI that the patient takes twice a day. Generally the infection should be cleared after the week, but if not the GP can prescribe another week, or the preferred option is to wait four weeks and do another breath test after another referral to save giving the person a second course of antibiotics.

Are there any opportunities to sell OTC or prescription products during or after the consultation?

People have to fast before the test, so they mostly want to go home and eat something as quickly as they can. We like to spend our time in the consultation to explain the process and possible outcomes of the test, so that’s our focus, although some people spot our weighing scale in the consultation room, and that often leads the conversation in that direction.

How have patients responded to the service?

During the initial stages of the pandemic, we couldn’t offer the service because of its nature, but now that we have started up again there is a sense of relief among patients that we can do it. The symptoms of H. pylori can be very uncomfortable for people so they are relieved to know what is going on and that something can be done, and in such an accessible way in the pharmacy.

We do see people suffering for a long time. One patient came to us last year: had a positive breath test, had the treatment, and was fine. Then a few months ago they rang up as they thought they were positive again, and they had an operation booked which they wouldn’t be able to have if they were positive for H, pylori. They got referred back to us; unfortunately the test was positive again and they were not able to have their surgery. But they had the treatment again and were able to reschedule.

Roughly how often each month do you carry out the service?

We were doing about three to four tests a month before the pandemic. At the moment it’s more like two or three, but it is picking up again.

How much do you charge for the service?

It’s free to the patient.

Roughly how much a month do you make from offering the service?

The service is commissioned locally, and we get a fee per test conducted – so if we see a repeat patient via another referral we get another fee.

Would you recommend offering this service to other contractors?

Yes, it’s a straightforward service and the more accessible it is to the patients, the easier it is for them to be seen and treated promptly.