Current Helicobacter pylori Diagnostics: Established Methods, Resistance Testing, and Emerging Approaches

Accurate diagnosis of Helicobacter pylori infection is required to detect active infection, confirm eradication, assess gastric pathology when indicated, and obtain antimicrobial resistance information that may guide treatment. This review evaluates the clinical roles, limitations, and implementation maturity of established, molecular, and emerging diagnostic approaches.

A narrative review was conducted using PubMed/MEDLINE, Embase, Web of Science, the Cochrane Library, and Google Scholar, prioritizing clinical guidelines, systematic reviews, diagnostic accuracy studies, multicenter validation studies, and directly relevant method-development research. Histology, rapid urease testing, and culture remain established biopsy-based methods, whereas urea breath testing and validated monoclonal stool antigen testing are the leading non-invasive options for detecting active infection and confirming eradication. Serology is useful only in selected settings because it cannot reliably distinguish current from previous infection. Culture provides phenotypic susceptibility results but is technically demanding. qPCR and targeted PCR provide faster, target-specific genotypic information, while next-generation sequencing may broaden resistance-variant detection in specialist or surveillance settings. Genotypic findings require antibiotic-specific interpretation because genotype-phenotype concordance varies. AI-assisted endoscopic interpretation, biosensors, LAMP, CRISPR-based assays, and string test-based sampling may address specific workflow gaps, but most remain adjunctive, selectively implemented, early translational, or investigational.

Diagnostic selection should begin with the clinical question and integrate patient risk, treatment history, medication exposure, local resistance patterns, specimen access, laboratory capacity, turnaround time, and available resources. Wider adoption of newer technologies requires external validation, standardization, quality assurance, regulatory readiness, economic assessment, and evidence that results improve clinical management.