Invasive and non-invasive Helicobacter pylori diagnostic methods in Iran

Helicobacter pylori is one the most common Gram-negative bacterial pathogens implicated in a wide range of gastrointestinal disorders including peptic ulcer, gastritis, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. Effective management of gastrointestinal disorders has highly relied on the accurate identification of H. pylori in the early stages of infections. There are two types of diagnostic methods to identify H. pylori infections including invasive and non-invasive approaches. Invasive methods mainly rely on the upper abdomen endoscopy and biopsy sampling and non-invasive methods include serological and molecular examinations, stool antigen, and urea breath tests. Based on the recent investigations in Iran, rapid urease test and histopathology have demonstrated high sensitivity and specificity compared to other means of diagnosis, and stool antigen tests seem to be the most common non-invasive methods. About the sensitivity and specificity of urine and salivary serologic tests, more investigation is warranted, and much remains to be elucidated. As a general rule, using a combination of non-invasive and invasive methods of H. pylori diagnosis, such as stool antigen test for screening and histopathology examination for precise diagnosis is the best option for treatment initiation.