Diagnostic methods for Helicobacter pylori infection
| Methods | Advantages | Disadvantages |
| Invasive | ||
| Histology | Degree of chronic inflammation and activity, diagnosis of premalignant lesions such as grade of atrophy and gastric intestinal metaplasia, malignancy and coccoid forms. | Need special skills, and costly observer-dependency; time-consuming; dependence of accuracy on the receiver of antibiotics, proton pump inhibitors (PPI); size,site and number of biopsies. |
| Culture | Specificity (100%), provides pattern of antimicrobial resistance. | Important location of the biopsies, digestive haemorrhage, recent treatments with antibiotics, PPI, bismuth; is expensive and time-consuming test. Sensitivity on the staff skill and culture media. |
| Rapid urease test | Rapid, inexpensive, high sensitivity and specificity (almost 100%). | False-negative: bismuth, antibiotics, PPI, achlorhydria and the prevalence rate of infection, bacteria density digestive haemorrhage. False-positive: Proteus mirabilis, Citrobacter freundii, Klebsiella pneumoniae, Enterobacter cloacae, Staphylococcus aureus. |
| Non-invasive or invasive | ||
| PCR | Antimicrobial susceptibility, fast, high sensitivity and specificity. | False-positive results due to detect DNA pieces of dead bacteria. |
| Non-invasive | ||
| Urea breath test | Ideal for evaluating treatment response in children over 6 years of age. | High false-positive results in children aged <6 years; false-negative in recent treatments with bismuth, PPI antibiotics, not to use in children as an initial diagnosis. |
| Stool antigen test | No age dependency; fast, easy; useful after therapy. | False-negative results in recent treatments with bismuth, PPI, antibiotics; dependency of accuracy on the cut-off value and treatment status. |
| Serology | Widely available, cheapest. | Sensitivity in children is low, not used to confirm the eradication, inability to detect acute or chronic infection. |
PPI, proton pump inhibitor.