DIAGNOSIS OF HELICOBACTER-PYLORI INFECTION - WHEN TO USE WHICH TEST AND WHY

Tests for the detection of Helicobacter pylori differ in many respects . The choice of test depends on the clinical situation. In symptomatic patients, endoscopy is an important tool for diagnosing peptic ulcer disease or other gastroesophageal lesions. A biopsy-based detection sy stem for H. pylori, such as the rapid urease test, microscopy or cultu re of the organism, is therefore appropriate. The diagnostic sensitivi ty will increase if more than one of these tests is performed. In asym ptomatic patients, a noninvasive test should be used, and serology wit h a titre is suitable in this situation. If the results prove positive , confirmation of H. pylori infection is recommended using a urea brea th test. Patients who have previously received H. pylori eradication t herapy and present with a recurrence of symptoms should receive furthe r eradication therapy if they are still H. pylori-positive, even if no endoscopic abnormality is found. A non-invasive test should be used a nd the urea breath test is the best option in these individuals, as se rology is not suitable within 6-12 months of eradication therapy. If t he breath test is unavailable, a biopsy-based test should be used. The outcome of H. pylori eradication therapy should be assessed using a n on-invasive test. The urea breath test is appropriate, as serology is not suitable posttreatment. The breath test should be performed 4-8 we eks after the end of treatment to avoid false-negative results caused by temporary suppression of the infection. If the breath test is unava ilable, a serology with a titre or a biopsy-based test must be used, a t least 6-12 months after the end of treatment.