Doing an H pylori test can be overwhelming, but you are in the right place! In this blog post, I am going to break down each H pylori test method, how they work, their strengths and weaknesses, and how to know if you need to ask your doctor to retest you.
I’ve been there too, sitting in a doctor’s office, feeling awful, and having just to trust that they are looking out for your best interest. And if you’ve been there too, you might understand the feeling: having intense symptoms that alter your ability to live a normal life, you go see your doctor and they recommend a test that you’ve never heard of to check for a bacteria you’ve never heard of. It’s a lot.
And then on top of that, many people get all the testing done, only to end up with negative results that leave them frustrated and unsure why they’re dealing with unrelenting stomach symptoms if everything looks “normal.”
Unfortunately, not all H pylori test methods are created equal, and missing an infection can keep you stuck in a cycle of unanswered questions and lingering symptoms.
So if you are ready to dive into all things H pylori testing so that YOU can take control of your health, let’s go!
Why Accurate H pylori Testing Matters
It’s not enough to just test for H pylori.
You also need to understand what your results mean and where the test method you used might fall short.
Not all H pylori tests are created equal and just because you have received a positive or a negative result, that isn’t always a definitive answer.
Some test methods are excellent for confirming an infection, while others are better at ruling one out. And knowing the difference can save you from unnecessary frustration and get you on the path to answers much faster.
Most importantly, if you have been struggling with persistent stomach symptoms like reflux or stomach pain despite a negative test result, the problem might not be your symptoms—it might be the accuracy of the test itself.
✨ Soothe & Support Your Stomach ✨
Struggling to plan meals that won't flare your stomach symptoms?
My new, free 5-day email series is packed with simple nourishing recipes, gut healing tips, and actionable strategies to help you find relief from your nagging symptoms.
So, I am here to say that I see you and that there is hope to find a root cause for your symptoms, even if you have gotten a test result that was less than helpful. Keep reading!
What Does “Test Accuracy” Really Mean?
Before diving into the specifics of each H pylori test method, let’s talk about what it means when we look at a test result, and try to understand how well we can trust that result to be true.
When you run a lab test, the result is either positive or negative. For H pylori testing:
- A positive result means the test detected H pylori in your gut.
- A negative result means the test didn’t detect H pylori.
In an ideal world, these results would be 100% accurate every time. But lab testing isn’t an exact science, and no test is perfect. Every test comes with the possibility of errors, such as:
- False positives, where the test mistakenly detects an infection that isn’t there.
- False negatives, where the test fails to detect an infection that is actually present.
When it comes to gut infections like H pylori and identifying a root cause of your symptoms, avoiding false negatives is especially important.
A false negative means you have an H pylori infection that the test didn’t pick up. This leaves you still searching for answers and delaying treatment for the real root cause of your symptoms.
False positives are also not ideal, as they could leave you doing unnecessary treatment to try to get a negative test result when in reality, your infection is already gone. But, when it comes to H pylori test methods, false positives aren’t as common.
Understanding the strengths and weaknesses of different test methods is key to avoiding frustration and enables you to take an active role in your health.
H Pylori Test Methods
Now that we have a better understanding of how lab testing works and what the terms “false negative” and “false positive” mean for us and our H pylori test results, let’s dive into each of the five major H pylori test methods.
We will go over four conventional test methods that you can get from your doctor’s office, and one functional test method that you can get from a functional practitioner.
Test Method #1: Stool Culture
One of the oldest methods for testing H pylori is the stool culture (or stool antibody test). If you’ve ever taken a biology class, this is probably the method that comes to mind when you think of testing for bacteria. Here’s how it works:
You provide a stool sample, which the lab uses to try and grow H pylori bacteria on a petri dish and looks for antigens associated with H pylori. If they succeed, the result is positive, confirming an active H pylori infection. If the bacteria don’t grow or if they don’t see any antigens, the result is negative.
Strengths of Stool Culture
- A positive result is highly reliable. H pylori won’t grow in the lab unless it’s present in your stool sample. If you get a positive result, you can be confident that you have an active infection.
Weaknesses of Stool Culture
- A negative result doesn’t necessarily mean you’re in the clear. To get an accurate result, several things have to line up perfectly:
- H pylori bacteria must travel from your stomach to your stool.
- Your collected stool sample must contain H pylori.
- The tiny portion of your sample used by the lab must also include H pylori.
Because of these challenges, it’s highly likely for a stool culture/stool antigen test to produce a false negative. This means you could have an H pylori infection, but the test simply didn’t detect it.
The Bottom Line
If your doctor uses a stool culture to test for H pylori, a positive result is very accurate, but a negative result isn’t definitive. If your symptoms persist despite a negative result, I recommend retesting with a more reliable method to rule out a false negative.
Test Method #2: Urea Breath Test
The urea breath test is one of the most commonly used methods for detecting H pylori—and for good reason. It’s quick, non-invasive, and generally very reliable when performed under the right conditions.
Here’s how it works: You drink a urea solution, and if H pylori is present in your stomach, the bacteria break down the urea into carbon dioxide. This CO₂ shows up in your breath and is measured by the test as a positive result. If H pylori isn’t present, the urea solution simply passes through your system, and the test registers a negative result.
Strengths of the Urea Breath Test
When done properly, the urea breath test is highly accurate with a low rate of false negatives. It’s non-invasive and provides quick, clear results, making it a convenient option for both doctors and patients.
Weaknesses of the Urea Breath Test
Accuracy can be compromised if you’re taking certain medications, such as:
- Proton pump inhibitors (PPIs)
- Bismuth-containing medications
These medications can interfere with the test by suppressing H pylori activity, leading to false negatives.
Unfortunately, I’ve seen many cases where clients were given a urea breath test while on a PPI or bismuth—without being told to stop these medications beforehand. And then when the test results come back negative, these clients are still left searching for answers and are without helpful steps forward to start improving their symptoms.
The Bottom Line
The urea breath test is an excellent option for detecting H pylori, as long as you’re not taking PPIs or bismuth. If you’re on these medications and can’t stop them, this test isn’t the right choice for you. In that case, I recommend functional stool testing, which we’ll cover shortly.
Test Method #3: Blood Antibody Test
The blood antibody test is one of the simplest ways to test for H pylori. It involves a quick blood draw to check for antibodies your immune system produces in response to the bacteria. While this sounds straightforward, there’s a significant limitation: this test cannot differentiate between a current infection and one you had months or years ago.
Strengths of Blood Antibody Test
A positive result indicates that your immune system has responded to H pylori, meaning you either have an active infection or had one within the past. This can be helpful as an initial test if you’ve never treated H pylori before.
A negative result is more definitive. It tells you that you do not have a current infection and haven’t had one in the last three months, making it a useful tool to rule out H pylori in some cases.
Weaknesses of the Blood Antibody Test
This method falls short when it comes to determining whether you have an active infection. If you’ve already treated H pylori, a positive result doesn’t confirm whether the bacteria is still present or if your antibodies are simply lingering from a past infection. Because of this, it’s not a good choice for re-testing after treatment.
The Bottom Line
The blood antibody test can be useful as a first step if you’ve never been treated for H pylori, but it’s not ideal for confirming an active infection or evaluating whether treatment was successful. Since it doesn’t test directly for the bacteria itself, I don’t typically recommend this as the go-to method for H pylori testing.
Test Method #4: Endoscopy
The endoscopy is the most invasive of the conventional H pylori test methods, but it’s not as accurate as you might think given the intensity of the procedure.
Here’s how it works: Under mild sedation, a doctor inserts a long tube with a camera and tiny scissors attached through your mouth and into your stomach. During the procedure, the doctor examines your stomach lining, which can help diagnose conditions like gastritis or ulcers. And while they are there, the doctor can also take small samples of your stomach lining to test for the presence of H pylori.
Strengths of the Endoscopy
A positive result means that H pylori was detected in the stomach samples taken during the procedure. This is a very reliable result—if H pylori is found, you can be certain it’s present and contributing to your symptoms.
Additionally, an endoscopy can provide valuable insights into the health of your stomach lining, making it useful for identifying other issues like inflammation or ulceration.
Weaknesses of the Endoscopy
False negatives are a significant limitation of this test. H pylori isn’t evenly distributed throughout the stomach, so if the doctor happens to take samples from areas where the bacteria isn’t present, the result will come back negative. Taking PPIs can also skew H pylori biopsy results, causing a false negative. This doesn’t mean you’re free of H pylori—only that it wasn’t detected in the specific sections sampled.
Given the invasive nature of the procedure, the cost, and the potential for false negatives, endoscopy is not my first choice for H pylori testing. While it can be helpful for diagnosing other stomach conditions, it’s not the most reliable method for ruling out H pylori entirely.
The Bottom Line
Endoscopy has its place for investigating broader stomach issues, but when it comes to H pylori testing, it’s not the most accurate or efficient choice. If you’re considering this procedure, keep in mind that a negative result doesn’t necessarily rule out an H pylori infection, and less invasive testing methods might provide better answers.
Test Method #5: DNA PCR Stool Test
The DNA PCR stool test is a functional stool test that stands out as the most accurate non-invasive method for detecting H pylori. Unlike conventional testing methods, this advanced test looks for the DNA of H pylori in your stool, making it my go-to choice for reliable results.
How it Works
Similar to a stool culture, you collect a stool sample and send it to the lab. But now, the lab extracts DNA from the sample to check for H pylori’s genetic material.
Here’s the key advantage: The actual H pylori bacteria doesn’t need to be present in the sample—only its DNA. Since H pylori leaves traces of its DNA behind as it exists in your gut, the chances of detecting it are extremely high if it’s there. This makes the DNA PCR stool test highly accurate for both positive and negative results.
Why It’s My Top Choice
Because of its precision, the DNA PCR stool test is my preferred method for H pylori testing with clients. This test method avoids the pitfalls of false negatives that are common in other methods.
While some critics argue that PCR testing may produce too many false positives, I’d rather treat a potential infection than risk missing one that’s actively causing symptoms. No test is perfect, so you have to weigh the pros and cons of potentially getting a false negative versus a false positive.
When to Use This Test
If you’ve tested negative using conventional methods but are still experiencing symptoms like reflux, nausea, or stomach pain, this is the ideal next step. This is the test I rely on with all my clients to identify H pylori and other gut infections accurately, allowing us to create effective treatment plans.
The Bottom Line
The DNA PCR stool test is one of the most accurate, non-invasive H pylori test methods. If other tests have left you without answers, this functional test can provide the clarity you need to move forward in your healing journey.
Plus, with this test method, you get so much additional information about your microbiome and intestinal health that the other four methods can’t provide.
Choosing the Right H pylori Test Method
Now that we’ve covered five different H pylori testing methods and looked at the strengths and weaknesses of each, let’s summarize to help you figure out which test method is right for your situation.
If You’ve Never Been Tested for H Pylori
If this is your first time testing for H pylori and you want to determine if this bacteria is behind your stomach symptoms, I recommend starting with the urea breath test. The breath test is the most accurate of the conventional test methods for both positive and negative results—as long as you’re not taking a PPI or bismuth.
If you are on PPIs or bismuth, the breath test won’t be reliable. In that case, a stool test is a better conventional option. While stool cultures can provide a definitive positive result, they often produce false negatives, so be prepared to explore further testing if your symptoms persist despite a negative result.
If You’ve Already Treated H Pylori
If you’ve recently completed H pylori treatment and want to check its effectiveness, the urea breath test or the GI-MAP functional stool test (DNA PCR stool testing) are the best options. The GI-MAP, in particular, is highly accurate and provides a wealth of additional information about your gut health.
For More Serious Symptoms or Additional Concerns
If your symptoms are more severe or if there’s concern about conditions like gastritis or ulcers, an endoscopy may be necessary. While it’s not the most reliable for ruling out H pylori, it can provide valuable information about your stomach’s overall health.
My Top H Pylori Test Method
In my practice, I always recommend the DNA PCR stool test, specifically the GI-MAP. This advanced test not only detects H pylori with incredible accuracy but also gives a comprehensive overview of your microbiome and intestinal health.
The insights from this test allow me to create targeted treatment protocols and long-term strategies to strengthen your gut’s defenses, reducing the risk of reinfection.
While the GI-MAP is an investment, it’s well worth it for the clarity and direction it provides. That said, if functional testing isn’t feasible right now, starting with a conventional test like the urea breath test is a fine option too!
The Bottom Line
There’s no single “best” H pylori test—it all depends on your unique circumstances and what you’re hoping to achieve through testing.
Whether you’re just starting to investigate your symptoms or confirming the success of a treatment, understanding the pros and cons of each test will help you make an informed decision and move closer to the answers you need.
I know navigating H pylori testing and interpreting results can feel overwhelming, but I hope this blog post has helped you feel more confident—whether you’re pursuing additional testing, discussing options with your doctor, or shifting your focus to healing after a negative result.
Final Thoughts: What to Do If You’re Still Symptomatic
Before we wrap up, I want to leave you with one more piece of advice.
If you have gone through H pylori treatment and found that you are in fact negative – that your infection has been eradicated, but you are STILL experiencing the same (or worse) symptoms, you are not alone.
It is incredibly common to go through H pylori treatment and still have symptoms.
Successfully eradicating H pylori is a huge step, but it’s not the end of the journey for many people.
H pylori can cause significant damage to your stomach lining and degrade your body’s stress resilience. And lingering symptoms often persist until you dedicate time to healing and reversing these effects.
If you’re still symptomatic even after H pylori treatment the best next step for you to help resolve your symptoms is to focus on healing your stomach and rebuilding your body’s resilience.
These two steps are key to making a full recovery and finally breaking free from the cycle of stomach symptoms.
To help you get started, I’ve created a free email series with actionable tips to kickstart your stomach healing. If you want expert advice on healing your stomach and reversing the negative impacts of H pylori, you can sign up at theguthealingninja.com/kickstart and have these strategies delivered straight to your inbox.
Jessica Washington is a Functional Diagnostic Nutrition Practitioner specializing in stomach health and H pylori. Drawing from her personal journey overcoming H pylori and over three years of experience, she has helped hundreds of clients naturally heal stubborn stomach symptoms like reflux, heartburn, and stomach pain through her signature programs and coaching.
