Posted: Tuesday, 13 July 2010 2:45 AM

Tags: The Journal of the American Association of Physician Assistants recently published Helicobacter pylori Infection: An update on diagnosis and management; the findings confirm that Urea Breath Testing is still the non-invasive test of choice for diagnosing H. pylori. H pylori, a bacteria that is responsible for a number of medical conditions affecting the gastrointestinal tract, including peptic ulcer and cancer, can be diagnosed with invasive or non-invasive testing.
The Journal of the American Association of Physician Assistants recently published Helicobacter pylori Infection: An update on diagnosis and management; the findings confirm that Urea Breath Testing is still the non-invasive test of choice for diagnosing H. pylori. H pylori, a bacteria that is responsible for a number of medical conditions affecting the gastrointestinal tract, including peptic ulcer and cancer, can be diagnosed with invasive or non-invasive testing.

Invasive tests examine the stomach lining via endoscopy. Non-invasive tests are performed on expired breath, blood (serum), or stool samples. Endoscopy with biopsy is an important diagnostic tool, yet in many cases, it is recommended that younger patients get treated for infection before performing endoscopy. Older patients and those with red-flag symptoms often undergo endoscopy.


Non-invasive H. pylori tests can be performed on expired breath, serum, and stool. For diagnosing H pylori, the non-invasive test of choice is the urea breath test. Both 13C-urea or 14C-urea can be used. When urea is ingested, it is hydrolyzed to labeled CO2 – and then it is exhaled. The amount of labeled CO2 suggests the likelihood of infection. 13C-urea has several advantages over 14C-urea: in addition to not generating ionizing radiation, it is approved for use in children and pregnant women.

Serologic, or blood, tests detect IgG antibodies to H pylori. There are a number of appropriate testing mechanisms available, including Western blot testing, immunochromatography, and enzyme-linked immunosorbent assay (ELISA). However, some blood tests will appear positive for patients with a history of H. pylori infection. In these cases, blood tests are not indicated.

A stool antigen test is an alternative to the breath test, as they both have high sensitivity and specificity and can be used to assess treatment success.


Studies aiming to determine the best test for diagnosing H pylori infection showed that stool and urea breath tests were both very accurate. One study performed in the UK revealed that 77% of patients would choose a urea breath test or stool antigen test if they knew that these are more accurate than blood tests; about 65% preferred the urea breath test.


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