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World J Gastroenterol. Jul 28, 2014; 20(28): 9299-9313
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9299
Helicobacter pylori infection - recent developments in diagnosis
Ana Isabel Lopes, Filipa F Vale, Mónica Oleastro
Ana Isabel Lopes, Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, 749-016 Lisboa, Portugal
Filipa F Vale, Centro de Patogénese Molecular, Unidade dos Retrovírus e Infecções Associadas, Instituto de Medicina Molecular e Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, 1749-016 Lisboa, Portugal
Mónica Oleastro, Laboratório Nacional de Referência das Infeções Gastrintestinais, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr Ricardo Jorge, 749-016 Lisboa, Portugal
Author contributions: Lopes AI planned the paper’s general structure, format and content; all the authors contributed equally to the paper and its final revision.
Correspondence to: Ana Isabel Lopes, Professor, MD, PhD, Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Av. Professor Egas Moniz, Código Postal 1649-035 Lisboa, Portugal. anaisalopes@sapo.pt
Telephone: +351-217-805000 Fax: +351-217-548215
Received: November 9, 2013
Revised: February 28, 2014
Accepted: April 15, 2014
Published online: July 28, 2014
Abstract

Considering the recommended indications for Helicobacter pylori (H. pylori) eradication therapy and the broad spectrum of available diagnostic methods, a reliable diagnosis is mandatory both before and after eradication therapy. Only highly accurate tests should be used in clinical practice, and the sensitivity and specificity of an adequate test should exceed 90%. The choice of tests should take into account clinical circumstances, the likelihood ratio of positive and negative tests, the cost-effectiveness of the testing strategy and the availability of the tests. This review concerns some of the most recent developments in diagnostic methods of H. pylori infection, namely the contribution of novel endoscopic evaluation methodologies for the diagnosis of H. pylori infection, such as magnifying endoscopy techniques and chromoendoscopy. In addition, the diagnostic contribution of histology and the urea breath test was explored recently in specific clinical settings and patient groups. Recent studies recommend enhancing the number of biopsy fragments for the rapid urease test. Bacterial culture from the gastric biopsy is the gold standard technique, and is recommended for antibiotic susceptibility test. Serology is used for initial screening and the stool antigen test is particularly used when the urea breath test is not available, while molecular methods have gained attention mostly for detecting antibiotic resistance.

Keywords: Helicobacter pylori, Diagnosis, Endoscopy, Histology, Culture, Urea breath test, Stool antigen test, Serology, Molecular methods

Core tip: Considering the importance of a reliable diagnosis in the setting of current recommendations for Helicobacter pylori (H. pylori) eradication therapy, recent developments in both invasive and non-invasive methods may further contribute to improving H. pylori detection. The manuscript presents an extensive overview of the major advances in endoscopy, histology, culture, urea breath test, serology, stool tests and molecular methods, emphasizing their major contributions and potential shortcomings.