Diagnosis of Campylobacter pylori infections: the "gold standard" and the alternatives.

Both direct and indirect techniques are available for the detection of gastric infections due to Campylobacter pylori. These techniques vary in their degree of efficacy, invasiveness, and convenience. They fall into five major categories, based on either the particular characteristic of the C. pylori organism or the manifestation of the C. pylori infection that they detect. The five categories include histologic examination of culture biopsy specimens, serologic examination, rapid urease tests, and carbon isotype breath tests. The observed efficacies of the techniques for detection of C. pylori are influenced by the standard with which they are compared. At present, the best candidate for the "gold standard" appears to be histologic detection by examination of multiple mucosal biopsy specimens.