Helicobacter pylori infection is prevalent among persons over age 60, is strongly associated with peptic and duodenal ulcer, and is caused by a microbe classified as a carcinogen. These factors combine to make the primary care physician key to proper diagnosis and treatment of H pylori infection. In 1998, the American College of Gastroenterology published an evidence-based guideline for the management of this infection. The guideline produced several fundamental recommendations that help clarify the management process: asymptomatic persons should not undergo testing, but testing should be performed on certain persons, testing should only be done if the intention is to treat; the choice of test is governed by the need for endoscopy; and several triple-therapy regimens are effective for eradication.