An evaluation of invasive and non-invasive tests for the diagnosis of Helicobacter pylori infection in Chinese

Background: Different tests are available for diagnosing Helicobacter pylor i infection. Aim: To compare the most commonly used tests either alone or in combination in Chinese patients with respect to routine clinical use or research purpo se. Methods: A total of 294 consecutive dyspeptic patients without previous H. pylori treatment were recruited. During upper endoscopy, biopsies were take n from the antrum and corpus, for a commercially available CLO-test, an in- house rapid urease test, culture, polymerase chain reaction and histologica l examination. Patients then received a C-13-urea breath test. The H. pylor i status of each patient was determined by a concordance of test results. Results: For routine clinical use, histology (antral plus corpus biopsies) had an accuracy of 100%,, whilst the rapid urease test had an accuracy of 9 9.7%. The C-13-urea breath test was equally reliable, with an accuracy of 9 4.5%. Combinations of two tests did not confer additional advantage over th e most accurate single test. For research purposes, the accuracy of using t he criteria of two positives out of three diagnostic tests was 100%, and eq uivocal results were not found. Conclusion: Histology with or without a rapid urease test was highly accura te for routine clinical use. Alternatively, the C-13-urea breath test was a n equally reliable non-invasive test. The two positives out of three tests approach was highly reliable in predicting H. pylori status of untreated Ch inese patients in a research setting.