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Helicobacter pylori Invasive Testing

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Helicobacter pylori Invasive Testing, H. pylori culture, Endoscopic Biopsy for H. pylori, Rapid Urease Test, CLO Test

  • See Also
  1. Helicobacter pylori Noninvasive Testing
  2. Helicobacter Pylori
  3. Peptic Ulcer Disease
  • Indications
  1. Dyspepsia evaluation
  • Tests
  1. H. pylori culture
    1. Test Sensitivity: 70-80%
    2. Test Specificity: 100%
  • Precautions
  1. Stop antibiotics for 4 weeks before Helicobacter Pylori testing
  2. Stop Proton Pump Inhibitors (PPIs) for 2 weeks before Helicobacter Pylori testing
  3. Only Serology and Rapid Urease Test are not affected by antibiotics and PPIs
  • Labs
  • Performed via Upper Endoscopy
  1. Histology (endoscopic biopsy) with Steiner's Stain
    1. Test Sensitivity: 70% (up to 95% in early studies)
    2. Test Specificity: 90% (up to 99% in early studies)
    3. Likelihood: LR+ 6.7, LR- 0.23
  2. Rapid Urease Test (e.g. CLO Test)
    1. Test Sensitivity: 67% (up to 93 to 97% in early studies)
    2. Test Specificity: 93%
    3. Likelihood: LR+ 9.6, LR- 0.31
  3. Helicobacter Pylori Culture (endoscopic biopsy sample)
    1. Test Sensitivity: 45% (up to 70-80% in early studies)
    2. Test Specificity: 98%
    3. Likelihood: LR+ 19.6, LR- 0.31
  4. References
  • Advantages
  1. Gold standard for H. pylori diagnosis
  2. Confirms cure for H. pylori
  • Disadvantages
  1. Requires endoscopic biopsy
  2. Sensitivity altered for histology and urease activity
    1. Proton Pump Inhibitors
    2. Antibiotics
    3. Bismuth
  • References
  1. Bordin (2021) Diagnostics 11(8): 1458 [PubMed]
  2. Gisbert (2006) Am j Gastroenterol 101(4): 848-63 [PubMed]
  3. Kayali (2018) Acta Biomed 89(8-S): 58-64 [PubMed]
  4. Meurer (2002) Am Fam Physician 65(7):1327-39 [PubMed]
  5. Snyder (1999) Can J Gastroenterol 13:585-9 [PubMed]