Diagnosis of Helicobacter pylori: invasive and non-invasive tests

Best Pract Res Clin Gastroenterol. 2007;21(2):299-313. doi: 10.1016/j.bpg.2006.11.002.


Helicobacter pylori infection can be diagnosed by invasive techniques requiring endoscopy and biopsy (e.g. histological examination, culture and rapid urease test) and by non-invasive techniques, such as serology, the urea breath test, urine/blood or detection of H. pylori antigen in stool specimen. Some non-invasive tests, such as the urea breath test and the stool antigen test, detect active infection: these are called 'active tests'. Non-invasive tests (e.g. serology, urine, near-patient tests) are markers of exposure to H. pylori but do not indicate if active infection is ongoing; these are 'passive tests'. Non-invasive test-and-treat strategies are widely recommended in the primary care setting. The choice of appropriate test depends on the pre-test probability of infection, the characteristics of the test being used and its cost-effectiveness.

Publication types

  • Review

MeSH terms

  • Antibodies, Bacterial / analysis
  • Antigens, Bacterial / immunology
  • Bacterial Proteins / immunology
  • Breath Tests
  • Endoscopy, Gastrointestinal
  • Enzyme-Linked Immunosorbent Assay
  • Feces / microbiology
  • Gastritis / pathology
  • Helicobacter Infections / diagnosis*
  • Helicobacter Infections / pathology
  • Helicobacter pylori* / enzymology
  • Helicobacter pylori* / immunology
  • Humans
  • Microscopy, Confocal
  • Sensitivity and Specificity
  • Urea
  • Urease / metabolism


  • Antibodies, Bacterial
  • Antigens, Bacterial
  • Bacterial Proteins
  • VacA protein, Helicobacter pylori
  • cagA protein, Helicobacter pylori
  • Urea
  • Urease