H. pylori is a common yet potentially troublesome and harmful bacteria. Testing for H. pylori involves several methods, each with its own advantages and limitations. Today, we will review several common testing methods, limitations to each, who orders them and discuss one particular method we prefer. It's important to note that while we have our preferred method, other coaches and providers may favor different approaches. We also recognize that science is ever-evolving, which may introduce new testing options. However, new methods aren't inherently better but they can be.
One point we want to make ahead of time prior to you reading through each method is that the degree of severity of symptoms is not necessarily equally correlated to levels of pathogenic overgrowth. For example someone who has notably moderate to low levels of h.pylori could be more symptomatic than someone who has high levels. This is not a hard rule but a possibility. It is also important to know that “Although more physicians treat patients with a positive H. pylori test, only half ensure eradication after treatment.” (read here) Now if you read our last blog you have an understanding that eradication may not be fully necessary however this is contextual.
Do we stand by "test, don’t guess"?
It depends! We firmly believe that context matters in every situation. Is it our first step? Very rarely, but that requires context. For someone with established nutritional and lifestyle foundations and/or long-standing symptoms, we are likely to suggest testing. However, if that same person has recently undergone one or more gut health protocols, we may opt to wait on testing. Again, it depends.
Is testing or retesting ever required?
The decision to test, retest, follow supplemental suggestions, follow through with professional referral that we may have suggested, or anything we have suggested is always up to our clients. Testing and even retesting is not always something we suggest. However, we adhere to a strong personal and professional moral and ethical standard of care. If we believe that testing and/or retesting is in the best interest of our client's health and safety, we will clearly communicate our recommendations. Ultimately, the choice of action is always with the client.
Our commitment is to provide education and resources to empower our clients to make informed decisions about their health. We pride ourselves on meeting clients where they are and working within their means, ensuring that all recommendations are practical and feasible for their unique situations. This approach is central to our decision-making process and overall philosophy.
H.Pylori Testing Methods
Note: These are examples of the most common testing methods. We discuss some companies. We will not cover every single company that offers H.Pylori testing.
1. Urea Breath Test
What It Is: The urea breath test is a very non-invasive procedure that measures the presence of H. pylori by detecting the bacteria's urease activity. The individual being tested ingests a urea solution labeled with a special carbon isotope. If H. pylori is present, the bacteria breaks down the urea, releasing carbon dioxide that is then measured in the patient's breath.
Limitations:
False Negatives:
It only detects HIGH levels, to which lower levels may be missed.
Also, as a reminder H.pylori can change shape (read more here). The coccoid form of H.pylori does not produce as much urease leading to false negatives. H.pylori can stay in this form for up to 1 year.
Patients need to stop taking certain medications, such as proton pump inhibitors (PPIs) and antibiotics, several weeks before the test to avoid false negatives.
Availability: Not all healthcare facilities have the necessary equipment to perform this test.
Sensitivity to Infection Status: As mentioned above it may not detect very low levels of infection.
2. Biopsy (via Endoscopy)
What It Is: A biopsy involves taking a small tissue sample from the stomach lining during an endoscopy. This sample is then tested for H. pylori using various methods, including histology, culture, or rapid urease testing.
Limitations:
Invasiveness: It is an invasive procedure that requires sedation and carries some risks associated with endoscopy. This is important to consider when contemplating the possibility of a retest.
Sampling Error: Oddly enough this testing method is often touted as the most accurate way to diagnose a H. pylori infection. However, although H,pylori may be present in the stomach it may not be located in the specific area where the biopsy is taken, leading to false negatives. It would be nice if bacteria were evenly colonized but alas it doesn't.
A 2017 study among practicing gastroenterologists reported gastric biopsy as the most common diagnostic method (59%) (read here and read here). We are not discrediting this the power of biopsy but it is important to understand the limitations with missing detection.
It is also worth noting that "Even under ideal conditions, H. pylori requires about 5 days to form visible colonies on solid media. By that time, any other bacteria or fungi present in the sample can overtake the culture." (read here)
When H.pylori is in the coccoid form it is not culturable (read here). Translated: it will be missed
Expense and Resources: It is more expensive and resource-intensive compared to non-invasive tests.
3. Blood Test
What It Is: The blood test detects antibodies to H. pylori in the patient's blood. A positive result indicates that the person has been exposed to the bacteria at some point.
Limitations:
Cannot Distinguish Current Infection:
The presence of antibodies does not necessarily indicate an active infection, as antibodies can remain in the blood long (6+ months) after the infection has cleared.
It relies on lab draws (IgG, IgA, IgM) - each test is interpreted differently and some people can be deficient depending on their health status. IgG could cause false negatives since some people only produce IgA levels.
Does not detect any other overgrown pathogens that could be contributing.
Limited Usefulness Post-Treatment: It is not useful for determining if the infection has been eradicated after treatment.
4. Stool Antigen Test
What It Is: This non-invasive test detects H. pylori antigens in a stool sample, indicating an active infection.
Limitations:
Sensitivity and Specificity: This is not a bad test, it is just not as specific nor as sensitive as qPCR testing that we will mention next. Detects H. pylori when at least 5,000 cells per gram of stool, which is a pretty high level so again potentially missing lower levels.
Sample Handling: Proper collection and handling of the stool sample are crucial for accurate results.
5. qPCR (Quantitative Polymerase Chain Reaction): ie: GI MAP by Diagnostic Solutions
What It Is: PCR (Polymerase Chain Reaction) is a technique used to amplify DNA, making it possible to detect specific genetic material from a sample. The GI Map uses qPCR (quantitative PCR), also known as real-time PCR, not only amplifies DNA but also quantifies the amount of DNA present in real time, providing data on the concentration of the target DNA sequence. The GI Map is highly sensitive and specific, capable of identifying even small amounts of bacterial DNA. It can detect as little as 0.1 cell per gram of stool. ie: 1 little microorganism per 1 gram of stool. It can even detect dormant microbes. It is VERY sensitive, which means interpretation needs to be thoughtful.
Limitations:
Cost: It is not a typical test that is covered by insurance. Although it may be covered by an HSA/FSA. A test can run $300-600+ depending on where you order from.
Patients need to stop taking certain medications, such as proton pump inhibitors (PPIs) and antibiotics, several weeks before the test to avoid false negatives.
There are other companies that offer stool testing. These companies do offer highly sensitive tests that are similar to the GI Map. Each company uses slightly different methods of testing with their own unique testing profiles Some companies get very robust. Robust does not necessarily equate to better. Here are 2 other companies:
GI Effects: Genova Diagnostics: PCR technology
GI 360: Doctor’s Data: PCR, MALDI-TOF technology
Choosing the right test for H. pylori depends on various factors, including the patient's symptoms, medical history, and the resources available. While each testing method has its strengths, it also has limitations that need to be considered.
Are you struggling with H. pylori, unpredictable digestive symptoms or not sure where to start with your health journey? If you’ve been feeling overwhelmed or unsure, our team at Fortify is here to help. Whether you're considering coaching or a one-time consultation, we're dedicated to providing personalized support and guidance to meet your needs.
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