What is the best method to detect H. pylori?

The mainstream of detection methods for H. Pylori infection are commonly recognized as Invasive Detection Method and Non-Invasive Detection Method.

Invasive Detection Method :

The gastric mucosa tissues are obtained through the endoscope, for the rapid urease test, histological examination or bacterial culture.

Non-Invasive Detection Method :

Instead of the gastric mucosa tissues, a variety of specimens such as succus gastricus, serum, saliva, feces, etc. could be used for a series of non-invasive detection methods including C13 and C14 breath tests, HPAb ( fecal sample ) tests, HPAg (serum/plasma / whole blood sample ) test, H.Pylori ( dental tarter sample ) test and so on.

The most commonly recognized 5 detection methods for H. Pylori infection :

I.Non-Invasive Detection Method:

1. H.Pylori Antibody Test:
HPAb test for serum/plasma/whole blood samples.
The assay procedure ( sample preparation/operation of the test ) and interpretation of result:

*Advantages :
HPAb rapid test kit is suitable for self-testing at home ( no restrictions of the operation environments ) with guaranteed performances of high accuracy and stability.
*Disadvantages :
For the cured patients that accepted antibiotic therapies before, the HPAb rapid test will still show positive test results regardless of previous or current H. Pylori infections. I.e., once infected, the antibody of H.Pylori will always exist and could be detected. The HPAb rapid test would barely differentiate whether it is initial infection or not.

2.H.Pylori Antigen Test :
HPAg Test for fecal sample.
The assay procedure ( sample preparation/operation of the test ) and interpretation of result :

Precautions :
* The HPAg rapid test only requires human fecal sample.
* It is convenient and suitable for most patients of all ages and types ( children / pregnant women / senior citizens included ).
* The antigen test of H.Pylori will easily show positive test result with high precision at the earliest stage once infected.

*Advantages :
HPAg rapid test kit is suitable for self-testing at home ( no restrictions of patients’ ages or types ) with zero sufferings of miserably sampling experiences. The whole process of rapid detection is safe, painless and non-invasive.
*Disadvantages :
Please pay more attention to the requirements of feces sample (size/volume) collection and preparation ( shake the buffer bottle to help the fecal sample dissolve thoroughly / squeeze the buffer bottle and add the mixed solution instead of the solid feces into the sample well on the test cassette ). Make sure there is no interference of sample / improper collection / incorrect operation.

3.H.Pylori Rapid Test Paper:
HP Test for Dental Tarter Sample.
Obtain the dental tarter sample with a toothpick then apply the sample into the test zone of the test paper. Observe the color changes and compare it with the color chart to read the test result. A very strong positive result might reveal itself within 1 minute.

Precautions :
* The Helicobacter pylori ( HP ) has been found to exist in the micro-anaerobic environments ( e.g. human gastric mucosa tissues ) in most cases while a very few could be found in the human oral cavity as well ( e.g. in human dental tarter ).
* However, the HP found from the human oral cavity does not imply its origin right from the gastric mucosa tissues of this very individual, nor exclude the influences by accidental contact externally. I.e., it is not the sufficient and necessary conditions to conclude the HP found in the dental tarter comes from gastric mucosa tissues, vice versa.

*Advantages :
Easier operation with relatively affordable price.
*Disadvantages :
The test result might be affected greatly by a series of interfering factors ( might even mislead the patient with a missed or false positive test result under some unpredictable circumstances ) such as improper sampling of the insufficient or missed analyte after teeth brushing, affection by medication or some certain kind of food, misreading of the color changes by naked eye due to individualized differences, etc. Or by external contact accidentally.

4. C13 and C14 Breath Tests :
The carbon 13 / Carbon 14 breath test system is universally acknowledged as “ the gold standard “ for H.Pylori detection and “ the milestones in the history of gastric disease testing ”. It is intended for professional use in professional institutions by professional operators to show confirmed test results. The patient is required to be either on an empty stomach before sample collection or receive the detection at least 3 hours later after meals. An urea capsule would be taken accompanied with 20 mL volume of warm water by the patient, then sit still, wait quietly for another 15 – 30 minutes. The patient sample should be collected in the specific exhalation card or special collecting bag for the test system to analyze and show the test result in couple of minutes. Please pay special attention to avoid the early leakage or rapture of the capsule in the mouth which may cause inaccurate test result.
Precautions :
* The restrictions below should be followed strictly before the C13 or C14 breath test is conducted, including :
* Stop taking antibiotics or traditional Chinese medicine ( TCM ) with antibacterial effects of all kinds at least 4 weeks prior to the test.
* Stop using Proton Pump Inhibitors ( PPI ) / Bismuth / H2-Receptor Antagonists at least 2 weeks prior to the test.
Avoid receiving acute upper gastrointestinal bleeding / gastrectomy surgery that might cause probable false negative or positive test result.

*Advantages :
Zero suffering ( or even painless ) / low or zero risks / satisfactory repeatability / high accuracy / most accepted confirmed test.
*Disadvantages :
For professional use only ( professional institution / professional operator ). The sampling process might be performed at home though, the specific exhalation card should still be sent back to the professional institution for further operation before the test result is available. Some C14 breath test might involve slight radioactive exposure so it is not applicable for children under 14 years old / pregnant women / breast-feeding women. The cost of C13 / C14 breath test is relatively expensive for regular monitoring after treatment.

II. Invasive Detection Method :

5. Rapid Urease Test :
During the invasive gastroscopy ( stomachoscopy ) on an empty stomach, some small pieces of gastric mucosa tissues should be obtained through the endoscopic biopsy and put into the reagent containing phenol red and urea ( in light yellow color ). The test result could be observed then in 5 – 30 minutes at room temperature. If the color does not change, it is considered as negative for Helicobacter Pylori. However, if it turns into the color of rose red or light red, it is considered as positive for Helicobacter Pylori.
Precautions :
* Stop using Proton Pump Inhibitors ( PPI ) / Bismuth / H2-Receptor Antagonists at least 4 weeks prior to the test.
* Be on a liquid or semi liquid diet at least 1 day prior to the test.
* Prohibition of food or water in the morning of the very test day must be followed to guarantee the gastric emptying status.
*Advantages :
Relatively high accuracy / easy operation / affordable cost / rapid detection accompanying the gastroscopy examination
Disadvantages :
Invasive test by electronic gastroscopy examination / living tissues of gastric mucosa required / test result only show the presence of bacterial infection ( with many influencing factors that could easily cause false negatives ). Therefore, the rapid urease test is not recommended as an evaluation test after eradication treatment.

III. Conclusion :
The Helicobacter Pylori ( HP ) infection is easy to infect and relapse. Most patients do not have typical symptoms at the early stage of infection. It is quite normal to ignore and miss, which ultimately lead to severe stomach diseases. Therefore, regular detection would greatly help in the early detection and treatment as well as reduction of the risk of gastric cancer.
These 5 detection methods for Helicobacter Pylori ( Non-invasive / Invasive ) listed above have their own advantages and disadvantages respectively. One may find the most appropriate detection method based in her / his actual situation.

Recommendations :
* More Emphasis
* More Regular Testing
* Earlier Detection & Treatment