**15. Conditions in which retesting may be considered**

In cases of non-ulcer dyspepsia (functional dyspepsia), which has a poor correlation with *H. pylori*, a test-and-treat strategy is typically used. However, if symptoms persist or recur following 6–12 months of treatment, retesting is indicated. For uninvestigated dyspepsia, retesting is indicated if symptoms recur or persist after 4 weeks of treatment [16]. In most cases of chronic gastritis, successful eradication leads to the healing of gastritis and a reduced risk of developing complications [16].

Certain risk factors may warrant surveillance in patients with *H. pylori* gastritis. These risk factors include:

Presence of precancerous lesions: In some cases, *H. pylori* gastritis can progress to more severe forms of gastritis, such as atrophic gastritis or intestinal metaplasia. These conditions are considered precancerous as they increase the risk of developing gastric cancer. Surveillance endoscopy may be recommended in patients with these precancerous lesions to monitor for any signs of dysplasia or gastric cancer.

Family history of gastric cancer: Patients with a family history of gastric cancer may have a higher risk of developing the disease themselves. In such cases, surveillance endoscopy might be considered to detect any early signs of gastric cancer.

Persistent symptoms or alarm features: If a patient continues to experience persistent symptoms such as recurrent abdominal pain, bleeding, or unintended weight loss despite successful eradication of *H. pylori*, further evaluation with endoscopy may be necessary to investigate the underlying cause.

## **16. Recurrence**

Several factors have been implicated in the recurrence of *H. pylori* infections. These factors include coming from a low socioeconomic background (low income), poor hygiene, dining out in establishments, and undergoing invasive approaches for diagnosis and treatment [17].
