Editing Helicobacter pylori (section)

==Diagnosis==
[[Image:pylorigastritis.jpg|thumb|right|''H.&nbsp;pylori'' colonized on the surface of regenerative epithelium ([[Warthin–Starry stain|Warthin-Starry silver stain]])]]
Colonization with ''H.&nbsp;pylori'' does not always lead to disease, but is associated with a number of [[stomach disease]]s.<ref name="Kusters2006"/> Testing is recommended in cases of [[peptic ulcer disease]] or low-grade gastric [[MALT lymphoma]]; after [[endoscopy|endoscopic]] resection of early [[gastric cancer]]; for first-degree relatives with gastric cancer, and in certain cases of indigestion. Other indications that prompt testing for ''H. pylori'' include long term [[aspirin]] or other [[non-steroidal anti-inflammatory]] use, unexplained [[iron deficiency anemia]], or in cases of [[immune thrombocytopenic purpura]].<ref name="Crowe 2019">{{cite journal |last1=Crowe |first1=Sheila E. |title=Helicobacter pylori Infection |journal=New England Journal of Medicine |date=21 March 2019 |volume=380 |issue=12 |pages=1158–1165 |doi=10.1056/NEJMcp1710945|pmid=30893536 |s2cid=84843669 }}</ref> Several methods of testing exist, both invasive and non-invasive.

Non-invasive tests for ''H.&nbsp;pylori'' infection include [[serological test]]s for [[antibodies]], [[stool test]]s, and [[urea breath test]]s. Carbon urea breath tests include the use of [[carbon-13]], or a radioactive [[carbon-14]] producing a labelled carbon dioxide that can be detected in the breath.<ref name="Jambi">{{cite journal |last1=Jambi |first1=LK |title=Systematic Review and Meta-Analysis on the Sensitivity and Specificity of (13)C/(14)C-Urea Breath Tests in the Diagnosis of Helicobacter pylori Infection. |journal=Diagnostics |date=7 October 2022 |volume=12 |issue=10 |page=2428 |doi=10.3390/diagnostics12102428 |doi-access=free |pmid=36292117|pmc=9600925 }}</ref> Carbon urea breath tests have a high [[sensitivity and specificity]] for the diagnosis of ''H. pylori''.<ref name="Jambi"/>

Proton-pump inhibitors and antibiotics should be discontinued for at least 30 days prior to testing for ''H. pylori'' infection or eradication, as both agents inhibit ''H. pylori'' growth and may lead to false negative results.<ref name="Crowe 2019" /> Testing to confirm eradication is recommended 30 days or more after completion of treatment for ''H. pylori'' infection. ''H. pylori'' breath testing or stool antigen testing are both reasonable tests to confirm eradication.<ref name="Crowe 2019" /> ''H. pylori'' serologic testing, including [[Immunoglobulin G|IgG antibodies]], are not recommended as a test of eradication as they may remain elevated for years after successful treatment of infection.<ref name="Crowe 2019" />

An endoscopic biopsy is an invasive means to test for ''H.&nbsp;pylori'' infection. Low-level infections can be missed by biopsy, so multiple samples are recommended. The most accurate method for detecting ''H.&nbsp;pylori'' infection is with a [[histological]] examination from two sites after endoscopic [[biopsy]], combined with either a [[rapid urease test]] or microbial culture.<ref name="Logan">{{cite journal | vauthors = Logan RP, Walker MM | title = ABC of the upper gastrointestinal tract: Epidemiology and diagnosis of Helicobacter pylori infection | journal = BMJ | volume = 323 | issue = 7318 | pages = 920–2 | date = October 2001 | pmid = 11668141 | pmc = 1121445 | doi = 10.1136/bmj.323.7318.920 }}</ref> Generally, repeating endoscopy is not recommended to confirm ''H. pylori'' eradication, unless there are specific indications to repeat the procedure.<ref name="Crowe 2019" />