Diagnosis of Helicobacter pylori infections

Hardly any other bacterial infection can be diagnosed with a similar variety of non-invasive and invasive tests as infection with H. pylori. Efficacy and specificity of well-proven tests such as urease test in biopsy specimens, histology, culture, and 13C breath test have been uniformly evidenced in numerous studies. Novel tests include molecular microbiological procedures, providing new opportunities for rapid detection of virulence factors and resistance genes, as well as antigen detection in feces. Though some open questions still need to be clarified, the latter test will gain major importance in the future. With the availability of the breath test and antigen detection in stool the need for the use of serological tests has been reduced, all the more so as the majority of the available quick tests have been shown to be of inadequate reliability. Well defined indications for the treatment of H. pylori infections are a major prerequisite for a reasonable use of this diagnostic armory.