Testing for Helicobacter pylori in clinical practice

It is now accepted that cure of Helicobacter pylori infection will result in healing of chronic active gastritis and will change the natural history of gastroduodenal ulcer disease. A variety of highly sensitive and specific diagnostic methods have been developed over the past few years to establish whether a patient is infected with this organism. The two major categories of diagnostic tests for H. pylori are invasive methods, which require endoscopy, and noninvasive tests in which endoscopy is not necessary. Invasive tests include rapid urease tests, histology, and culture. Noninvasive tests include various methods of antibody detection and carbon-labeled urea breath tests. This review describes the characteristics, appropriate uses, and comparative accuracy of the available diagnostic tests for detection of H. pylori. It offers suggestions on the test of choice to establish a patient's H. pylori infection status in different clinical settings.