The most important diagnostic modalities for Helicobacter pylori, now and in the future.

CURRENT DIAGNOSTIC METHODS

Helicobacter pylori infection plays a central role in the pathophysiology of gastrointestinal disease, and its accurate diagnosis and successful eradication is crucial in a wide range of different circumstances. Currently, serology is recommended for initial screening, followed by histology and/or culture to confirm the diagnosis before treatment. Since H. pylori is developing greater resistance to certain antibiotics, culture is becoming increasingly important in some populations to test for susceptibility to antibiotics. To confirm eradication after treatment, the urea breath test is used. This test is presently the best non-invasive test to determine eradication. NEW APPROACHES: Considerable efforts are being made to improve diagnostic methods, and a host of new or improved approaches can be expected in the near future. For general screening, tests are being developed that use whole blood and can be used by general practitioners to give rapid results in a cost-effective manner. The evidence so far suggests that these new 'office' tests are not as accurate as laboratory tests, but they are nevertheless important for general diagnostic purposes. Serological tests for cagA antibodies and immunoblot tests are also under development. New biopsy-based tests include the development of a true rapid urease test which will give accurate results in 1 h. Polymerase chain reaction/DNA enzyme immunoassay detection is another field receiving attention. Non-invasive direct tests of the future are likely to include the use of the polymerase chain reaction in faeces. This paper reviews current diagnostic modalities for H. pylori and gives an overview of expected future developments.