In our previous article, we explained what Helicobacter pylori (H. pylori) is, how the infection is transmitted, and why this bacterium attracts so much attention from physicians.
The next step is understanding when testing is actually necessary, which diagnostic methods are truly reliable, and why not all tests are equally useful.
Although many different tests are available, their diagnostic value varies considerably. Modern international guidelines clearly identify which methods should be used for the initial diagnosis and which are appropriate for confirming successful treatment.
When Should You Be Tested for Helicobacter pylori?
Testing is recommended when the result is likely to influence further management and treatment decisions.
The most common indications include:
- peptic ulcer disease (gastric or duodenal ulcer);
- gastric MALT lymphoma;
- atrophic gastritis;
- dyspepsia and other symptoms of stomach or esophageal disease;
- unexplained iron deficiency anemia.
Testing may also be recommended for people at increased risk of gastric cancer, such as those with a family history of the disease, and for certain patients before long-term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, or low-dose aspirin.
What Diagnostic Methods Are Available?
Diagnostic methods can be divided into two major groups.
Non-invasive tests, which do not require gastroscopy:
- ¹³C urea breath test
- Helicobacter pylori stool antigen test
Invasive tests, performed during upper gastrointestinal endoscopy (gastroscopy):
- histological examination of gastric biopsy specimens;
- rapid urease test;
- PCR testing of biopsy samples.
There is no single test that is ideal for every patient.
The choice depends on the patient's age, clinical situation, whether gastroscopy is indicated, and whether the goal is initial diagnosis or confirmation of eradication after treatment.
According to current international guidelines, the most accurate non-invasive tests are the ¹³C urea breath test and the monoclonal stool antigen test.
¹³C Urea Breath Test
The ¹³C urea breath test is considered one of the most accurate non-invasive methods for diagnosing Helicobacter pylori.
It is used for:
- initial diagnosis;
- confirmation of successful eradication after treatment.
During the test, the patient drinks a solution or swallows a capsule containing urea labeled with the stable carbon isotope ¹³C.
If H. pylori is present, the bacterial enzyme urease breaks down the urea, and the reaction products are detected in the patient's exhaled breath.
The test has excellent sensitivity and specificity and is regarded as one of the reference standards for diagnosing H. pylori without the need for gastroscopy.
How Is the Test Performed at A Clinic?
Since June 2026, the ¹³C urea breath test has been available at A Clinic.
It is important to understand that the accuracy of the test depends not only on the method itself but also on the equipment used. Some breath tests offered by medical facilities still rely on outdated systems that do not meet current international standards.
At A Clinic, testing is performed using validated equipment with standardized interpretation of results.
Preparation
To ensure accurate results:
- arrive in the morning on an empty stomach or at least 8–10 hours after a light meal;
- small amounts of water are allowed;
- avoid alcohol and overeating the day before;
- do not smoke for 1 hour before the test;
- wait at least 4 weeks after finishing antibiotics, bismuth preparations, or sucralfate;
- stop proton pump inhibitors (PPIs) for at least 2 weeks before testing;
- avoid excessive physical and emotional stress the day before.
The test is available daily without an appointment.
The entire procedure, including the result, takes approximately 30 minutes.
Helicobacter pylori Stool Antigen Test
The stool antigen test is another highly accurate non-invasive method and has diagnostic performance comparable to the breath test.
The most reliable assays use monoclonal antibodies.
This test is used for:
- initial diagnosis;
- confirmation of eradication after treatment.
Preparation is the same as for the breath test:
- at least 4 weeks after antibiotics;
- at least 2 weeks after stopping PPIs.
Accurate results also depend on proper sample collection and transportation.
Currently, most laboratories in Georgia use rapid antigen tests. Monoclonal antibody testing is not yet available locally, so A Clinic sends stool samples to a European laboratory.
Patients receive a special collection kit at the clinic, and our staff provide detailed instructions for sample collection.
Gastroscopy with Gastric Biopsy
If gastroscopy is clinically indicated, H. pylori can be diagnosed using gastric biopsy specimens collected during the procedure.
The main advantage of this approach is that it allows physicians not only to detect the infection but also to assess the condition of the stomach lining, including:
- gastritis;
- atrophy;
- intestinal metaplasia;
- peptic ulcers;
- suspicious lesions.
This is particularly important for patients at increased risk of gastric cancer.
Gastroscopy should not be performed solely for H. pylori testing unless there are additional medical indications.
The most informative biopsy-based method is histological examination, in which a pathologist evaluates specially stained tissue samples under a microscope.
Rapid Urease Test
The rapid urease test is performed during gastroscopy.
It is based on the ability of H. pylori to break down urea, causing a change in the pH of the testing medium.
Results are usually available within minutes or hours.
However, this method has a relatively high false-negative rate. Therefore, a negative result does not always exclude infection and may require confirmation using more reliable diagnostic methods.
PCR Testing
Polymerase chain reaction (PCR) detects Helicobacter pylori DNA.
PCR performed on gastric biopsy specimens has the greatest clinical value because it can identify not only the infection itself but also genetic mutations associated with antibiotic resistance, particularly resistance to clarithromycin.
PCR testing of stool samples is not recommended as a routine diagnostic method for active infection in most international guidelines.
At present, PCR testing is not available in Georgia.
Blood Test for Helicobacter pylori
A blood test detects IgG antibodies, not the bacterium itself.
A positive result simply indicates previous exposure to H. pylori.
Antibodies may remain detectable for months or even years after successful treatment.
For this reason, blood testing:
- cannot distinguish active from past infection;
- cannot be used to confirm eradication;
- is not recommended for routine diagnosis according to current international guidelines.
How Is Helicobacter pylori Treated?
Treatment always consists of combination therapy.
Most treatment regimens include:
- a proton pump inhibitor (PPI);
- two or more antibiotics;
- bismuth preparations when indicated.
Treatment typically lasts 14 days.
Does Everyone with Helicobacter pylori Need Treatment?
In most cases, treatment is recommended once active infection has been confirmed, as eradication reduces the risk of peptic ulcers, gastrointestinal bleeding, and gastric cancer.
However, treatment decisions should always be individualized and based on reliable confirmation of active infection.
Why Can Treatment Fail?
The most common reasons include:
- antibiotic resistance;
- treatment courses that are too short;
- missed doses;
- outdated treatment regimens that do not account for local resistance patterns.
Why Is It Important to Confirm Successful Treatment?
Even if symptoms disappear completely, this does not necessarily mean the bacterium has been eradicated.
For this reason, eradication should always be confirmed after treatment.
Follow-up testing should be performed:
- at least 4 weeks after completing antibiotics;
- at least 2 weeks after stopping proton pump inhibitors.
Only two methods are recommended for confirming successful eradication:
- the ¹³C urea breath test;
- the Helicobacter pylori stool antigen test.
Key Takeaways
Suspected Helicobacter pylori infection is not a reason to order random tests or begin treatment without medical guidance.
Choosing the correct diagnostic method is essential to confirm active infection, select the most appropriate treatment regimen, and accurately assess whether treatment has been successful.
If you have upper gastrointestinal symptoms, have been diagnosed with Helicobacter pylori, or are unsure how to interpret previous test results, schedule a consultation.
During your appointment, we will determine whether testing is necessary, select the most appropriate diagnostic method, and develop an individualized treatment plan if needed.