Table 4

 Recommendations for diagnosis of H pylori formulated in the Maastricht III Consensus Report, with levels of scientific evidence and grades of recommendation

RecommendationsLevel of evidenceGrade of recommendation
The non-invasive tests that can be used for the test and treat strategy are UBT and the stool antigen tests. Certain kits for serology with high accuracy can also be applied1aB
PPI is a source of false negative diagnostic tests except serology. PPIs should be stopped for at least 2 weeks before performing a diagnostic test1bA
Serology should be considered as a diagnostic test when other diagnostic tests might be false negative, such as in patients with bleeding ulcers, gastric atrophy, MALT lymphoma, and recent or current use of PPIs and antibiotics2B
The serological tests are not all equivalent and different tests may be applied in different situations2bB
The detection of specific H pylori antibodies in urine and saliva has no current role in patient management but can he helpful for epidemiological studies1bA
Serology based near doctor-patient tests have no current role in the management of H pylori infection1A
Detection of H pylori pathogenic factors and the study of host genetic polymorphisms is not helpful in the management of H pylori infection3bD
It is recommended that a follow-up evaluation to confirm successful eradication be performed after H pylori eradication with UBT if available. If not available a laboratory based stool test, preferably using monoclonal antibodies, could be used1bA
Culture and antimicrobial sensitivity testing should be routinely performed:
Before clarithromycin based treatment, if primary resistance to clarithromycin is greater than 15–20% in the respective area
After two treatment failures with different antibiotics1bB
Monitoring of primary antibiotic resistance should be carried out in reference laboratories in different areas:
In patients presenting for endoscopy without pretreatment, a positive rapid urease test is sufficient to initiate treatment2A