H. pylori testing: All methods are not created equal

H. pylori stool antigen testing for initial diagnosis and eradication confirmation testing

H. pylori infection is the greatest known risk factor for gastric cancer.1 Although
H. pylori infections are typically asymptomatic and do not require treatment, 20-25% of patients develop peptic ulcers or gastric cancer.


H. pylori stool antigen test or H. pylori UBT?

Both UBT and stool antigen tests offer excellent sensitivity and specificity for initial diagnosis of H. pylori infection and posttreatment testing3; however, there are significant differences between the two tests. H. pylori stool antigen tests require no patient preparation prior to sample collection, and samples can be transported and stored at room temperature for up to 96 hours, with results available in less than an hour.

UBT requires specialized equipment for analysis and may not be recommended for children or patients who are or may be pregnant or are breastfeeding due to the administration of radiolabeled urea. Unlike stool antigen testing, UBT requires the discontinuation of PPI and bismuth compounds before testing, for which patients are often uncompliant. H. pylori stool antigen tests offer a more cost-effective and workflow-friendly solution compared to H. pylori UBT.

Additional information

H. pylori Stool Antigen Testing

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  2. Ho, J.J.C., Navarro, M., Sawyer, K., Elfanagely, Y., Moss, S. F. Helicobacter pylori antibiotic resistance in the United States between 2011 and 2021: A systematic review and meta-analysis. Am J Gastroenterol. 2022. 117(8):1221–1230. doi: https://doi.org/10.14309/ajg.0000000000001828.
  3. El-Serag H.B., Kao J.Y., Kanwal F., et al. Houston Consensus Conference on Testing for Helicobacter pylori Infection in the United States. Clin Gastroenterol Hepatol. 2018. 16(7):992-1002.e6. doi: https://doi.org/10.1016/j.cgh.2018.03.013
  4. Theel E.S., Johnson R.D., Plumhoff E., Hanson C.A. Use of the Optum Labs Data Warehouse to assess test ordering patterns for diagnosis of Helicobacter pylori infection in the United States. J Clin Microbiol. 2015. 53(4):1358-60. doi: https://doi.org/10.1128/JCM.03464-14.
  5. Talley, N.J., Ford, A.C. Functional Dyspepsia. N Engl J Med 2015. 373(19):1853-1863. doi: https://doi.org/10.1056/nejmra1501505.
  6. Lee, J.Y. and Lyerly, D.M. Why stool antigen testing outperforms serology in identifying H. pylori. Clinical Laboratory Products. doi: https://tinyurl.com/488p689w