Out of the numerous available tests, which one is recommended for diagnostics of Helicobacter pylori infection?
Peter Malfertheiner: It depends very much on the clinical condition. If the patient is young and has dyspeptic symptoms, we can recommend noninvasive testing, and the best noninvasive tests, which also indicate current infections, are the breath test – so called 13C urea breath test – or stool antigens. Only if these tests are not available, one could also make use of a serological test.
However, if the patient presents with symptoms that are also severe, like weight loss, anemia, then endoscopy with histology is absolutely mandatory. In elderly patients, above the age of 50 years, we recommend as the first diagnostic approach to endoscope and take biopsies for further processing – the histological grading and also the detection of H pylori.
And there is a third situation where we recommend to perform endoscopy with biopsies for culture if there are repetitive failures in treatment in order to determine the susceptibility of H pylori to different antibiotics.