Noninvasive and invasive testing methods for Helicobacter pylori
| Testing method | Pros | Cons | Cost (approximate) | Sensitivity | Specificity |
|---|---|---|---|---|---|
| Invasive tests | |||||
| Endoscopic biopsy | Allows direct visualization of H pylori infection Allows for histological evaluation | Discomfort and risk of complications | $$–$$$ | 95%–98% | 95%–98% |
| Rapid urease test | Quick results (usually within minutes) Relatively low cost | False negatives can occur with recent proton pump inhibitor use or active bleeding | $–$$ | 90%–95% | 95%–98% |
| H pylori culture | Allows for antibiotic susceptibility testing | Time-consuming and labor-intensive | $$–$$$ | Variablea | Variablea |
| Molecular testing (gastric tissue) | High sensitivity and specificity Can detect resistance mutations | Requires specialized equipment and expertise | $$–$$$ | 90%–95% | 90%–95% |
| Noninvasive tests | |||||
| Stool antigen test | Easy to collect specimens | May yield false negatives if antigen levels are low | $–$$ | 90%–95% | 90%–95% |
| Molecular testing (stool) | Easy to collect specimens High sensitivity and specificity | Requires specialized equipment and expertise | $$–$$$ | Variable | Variable |
| Serology (blood test) | Easy to perform | Cannot distinguish current infection from past exposure False positives can occur | $–$$ | 80%–85% | 80%–85% |
| Urea breath test | Well tolerated High sensitivity and specificity | Requires abstaining from certain medications (eg, antibiotics, proton pump inhibitors) before the test False positives can occur in the presence of urease-producing bacteria other than H pylori | $$–$$$ | 95%–98% | 95%–98% |
| GastroPanelb | Provides comprehensive information on gastric health | Limited availability Interpretation may be complex | $$$ | Variable | Variable |