Detection of Helicobacter pylori infection: when to perform which test

This paper reviews current diagnostic techniques for Helicobacter pylori in fection and critically questions their value under different diagnostic cir cumstances. As long as we do not have general treatment recommendations for H. pylori infection, endoscopy is still the basis for primary diagnosis be cause it assesses therapy indications. In addition, histology characterizes the gastroduodenal lesions observed and may reveal malignant diseases, New rapid urease tests from the biopsies are inexpensive. simple, and quick gi ving results reliably within 1 h. Culturing H. pylori from gastric samples after therapy failure and testing the strains for antimicrobial susceptibil ity is becoming increasingly important with higher prevalence of drug resis tances. Nonendoscopic tests are more convenient to the patient. Serological tests inexpensively detect circulating IgG or IgA antibodies. However, ins pite of the cost attractiveness, serology might be problematic in indicatin g present H. pylori infection. The tests of choice for noninvasive monitori ng therapy success or failure are the C-13-urea breath test and the faecal antigen immunoassay. Both tests are also of value for first diagnosis in ch ildren when endoscopy is not indicated. In the future, serological detectio n nf virulence factors and polymerase chain reaction with molecular fingerp rinting might help to identify H. pylori strains strains with high pathogen icity or antibiotic resistance.