TITLE:
A Narrative Review of Diagnostic Methods for Helicobacter pylori: Comparative Performance of Invasive, Non-Invasive, and Molecular Tests
AUTHORS:
Brenda John Ngowi, Hongzhang Shen
KEYWORDS:
Helicobacter pylori, Diagnosis, Invasive Tests, Non-Invasive Test, Urea Breath Test, Molecular Diagnostics, Stool Antigen Test
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.8,
August
31,
2026
ABSTRACT: Background: Helicobacter pylori is one of the most prevalent bacterial pathogens worldwide and is associated with chronic gastritis, peptic ulcer disease and gastric cancer. Accurate diagnosis is essential for timely treatment, successful eradication and prevention of disease progression and associated complications. Aim: This review evaluates the effectiveness of the major diagnostic methods used for the detection of H. pylori by comparing their sensitivity, specificity, diagnostic accuracy, clinical utility and limitations across different healthcare settings. It also examines factors influencing diagnostic performance and discusses appropriate diagnostic strategies for different clinical context. Methods: The narrative review summarizes studies published between 2020 and 2024 that were retrieved from PubMed, Scopus, Google scholar, Web of science and other various pages. Literature was identified using the key words Helicobacter pylori, diagnostic methods, urea breath test, stool and Polymerase chain reaction (PCR). Relevant clinical guidelines, systematic reviews, meta-analyses and representative original studies were selected to provide an overview of current diagnostic approaches and emerging trends. Results: Comparative analysis showed that the urea breath test (UBT) demonstrated the highest overall diagnostic accuracy for detecting active Helicobacter pylori infection, while the monoclonal stool antigen test (SAT) provided comparable performance with greater cost-effectiveness and practicality in resource-limited settings. Histology was generally more sensitive than culture and rapid urease testing (RUT), particularly in patients with low bacterial density, whereas culture remained indispensable for antimicrobial susceptibility testing. Molecular methods, especially polymerase chain reaction (PCR), exhibited high diagnostic sensitivity and enabled the detection of antimicrobial resistance-associated mutations, although their use is constrained by cost and laboratory infrastructure. Conclusion: No diagnostic accuracy across all methods was influenced by medication exposure, particularly proton pump inhibitors, antibiotics, and bismuth, as well as biopsy sampling, bacterial load, and clinical conditions. Overall, the evidence indicates that the optimal diagnostic approach should be selected according to the patient’s clinical presentation, medication exposure, and available healthcare resources.