What Is New in Helicobacter pylori Diagnosis. An Overview

Abstract

Helicobacter pylori infection remains one of the most prevalent infections worldwide, especially in low-resource countries, and the major risk factor for peptic ulcer and gastric cancer. The "test-and-treat" strategy is recommended by several guidelines and consensus. The choice of testing method is based on patient age, presence of alarm signs and/or symptoms, use of non-steroidal anti-inflammatory drugs, as well as local availability, test reliability, and cost. Culture is the gold standard to detect H. pylori and, possibly, to perform susceptibility testing, however, it requires upper endoscopy and dedicated labs. Recent advances in molecular biology have provided new strategies in detecting infection and antimicrobial resistance without invasive tests. In this review we attempt to offer a comprehensive panorama on the new diagnostic tools and their potential use in clinical settings, in order to accomplish specific recommendations.

Keywords: Helicobacter pylori; antibiotic resistance; artificial intelligence; molecular techniques; testing.

Figure 1

Images of different endoscopic patterns related to H. pylori infection. Specific features of the gastric angulus (a) in a 30-year-old man H. pylori-positive [14]. Gastric antrum showing (b) a “spotty pattern”, (c) a “cracked pattern” and (d) a “mottled pattern” observed by white light endoscopy [24]; (e) orange lesion (arrow), suggestive of early gastric cancer in the antrum, surrounded by spread intestinal metaplasia [25]. By using linked color imaging (f) the gastric fundus [28], and (g) the antral mucosa appeared massively red [29]. (h) Reddish, depressed lesion observed in the greater curvature with conventional white light endoscopy 36 months after H. pylori eradication [23].

Figure 2

Invasive, non-invasive methods and molecular testing to detected H. pylori and its antibiotic resistance.

Figure 3

Diagnostic evaluation to detect H. pylori infection and its gastric mucosa sequelae.