There are a several standard tests for assessing the presence of H. pylori. The main methods are:
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Endoscopy (gastroscopy) - One or more histological samples of the stomach or intestinal lumen are removed for analysis. Endoscopy is rarely used for the detection of H. pylori alone; it is generally used to identify or rule out other stomach maladies. This testing option is invasive and expensive and requires special training and equipment.
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Antibody Testing - Antibody testing relies upon the detection of IgG antibodies specific to H. pylori. Its advantages are its low cost and widespread availability. Some drawbacks, however, limit its use in clinical practice. A meta-analysis found its overall sensitivity and specificity to be 85% and 79%, respectively. Regarding H. pylori blood tests, the ACG 2007 guidelines state that "… a positive test is no better than a coin toss in predicting the presence of active infection."
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13C-Urea Breath Test (UBT) – Ingested 13C labeled urea is metabolized in the presence of H. pylori to yield CO2. The labeled gas is absorbed across the gastric mucosa and is subsequently measured in the patient’s expired breath. The ACG (American College of Gastroenterology) claims that the urea breath test provides reliable means of identifying active H. pylori infection before antibiotic therapy. Moreover, the ACG asserts that the UBT is the most reliable non-endoscopic test to document eradication of H. pylori infection
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Stool Antigen Test - This laboratory test can detect foreign proteins (antigens) in stool samples that are associated with H. pylori infection. Stool samples require patient compliance, are inconvenient to handle, and results are not immediately known